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Table of Contents

• Setup
• Pre-Billing Process
• Billing Via Claims Management Widget
• Beginning of Each New Month
• Batch Summary Widget
• Remit Summary Widget
• Close Books

Setup

ADMIN Module: People and Places

• Sites—mumms Liaison will ensure each site is set up with proper NPI, billing address and other information necessary for claims submission and will turn on “ENABLE LIVE BILLING” WHEN READY. See “Admin Module” instructions for more information.
• When ready, Mumms Liaison will turn on “ENABLE LIVE DDE” to be able to import claims status from DDE as well as to check a patient’s Medicare eligibility.
• Roles—ensure that billing rates have been entered for all billable/reportable roles
• Facilities—ensure that rates for room and board have been entered for each facility if Medicaid sets rates per facility. Ensure that the ‘R&B” checkmark is clicked for each facility in which there is a potential for billing R&B for a Medicaid recipient.

ADMIN Module: Billing and Financial

• Adjustment Reasons—choose from data base the write off codes commonly seen on 835s and Remits (such as 253 2% Sequestration, 142 Patient Portion, etc) or create your own.
• Hospice Election Definition—Medicare recertification is set by default. Other patterns can be created (such as “every 60d”). Set whether signatures are required to drop a claim; set whether F2F is required. Once set, each Carrier can be matched with their required recertification pattern.
• Insurance Carriers—choose from list of providers.
  • Rates & Codes Tab: Ensure each carrier’s contracted rates are set. NOTE: if contracted rates are not entered, the rates default to Medicare rates.
  • Details Tab: Ensure type of bill, required prior authorization, pattern for recertification, etc are set. Submitter ID, Contract ID, etc can be set up separately for different sites (for multi-site hospices).
  • Discharge Day Billing Rules Tab: set up for each carrier. Default is Medicare settings.
• Physician Services—set ‘favorite” list of physician billing codes as well as desired billing rates. Note: codes and rates are uploaded from CMS annually.
• Room & Board Rate Tiers—Set rates by tier if required by State Medicaid.
• Medicare Intermediary—set for each Site. When ready to begin sending NOEs/NOTRs/Claims, enter current DDE log in. IMPORTANT: if using live DDE calls each time DDE login changes, this information needs to be entered into HB ASAP to ensure that claims and claim status retrieval is not interrupted.

ADMIN Module: Persons

• Each DDE user must enter their DDE credentials along with application ID See Tip Sheet: Status of Claim/Eligibility Set up. IMPORTANT: Each time DDE requires password update the new password must be entered into ADMIN/Persons/DDE Credentials.
• Billers will need to have a “Role” from within the Financial Role Group in order to access the billing widgets and reports.

Pre-Billing Process

Be sure and review AT LEAST the reports and widgets below in preparation for claims submission each month. NOTE: the financial widgets, such as Billing Report and Claims Management float, and the Financial Reports (such as AR Reconciliation) are ONLY available to anyone having a role listed under “Finance”.

Reports

• Pt Days by LOC—Check Admissions, Discharge and Pts Served to see that all days at different levels of care (GIP, CC, IPR, Routine) are correct as well as various “locations” of care (such as Assisted Living, NH, etc) have been accurately entered into PIM. Verification of each will ensure that the appropriate revenue codes and /or Q-codes are correct on claims.
• Room and Board— Check to ensure that correct billing rates and patient portion (if applicable) have been entered for any patient in a billable room and board status.
• Visit Report— Sort by patient to view all visits that have been made during the time period. Check for gaps. Also view all billable physician visits that have been entered along with the HCPCS code and rate on this report.
• Exception Report: reports any errors affecting claims.
• PreBill Report: Download from Claim Management Widget/Not Sent tab/Downloads. This report will show all billable days, revenue codes, visits & medications (M/C Claims only), R&B charges if applicable.

Widgets

The widgets listed here will assist in the Pre-Billing process.

• Claim Errors—click Claim Errors (bottom 1/3 of the PATIENT drawer to see the “Exceptions” list. Click into the patient’s file to fix the error. Tab “Claim Error” will also list the error(s).
• Authorizations—See a listing of any patient whose authorization is expiring/expired. See details under Reports & Widgets section of the User Instructions.
• Billing Report—This widget allows review of each claim prior to submitting. Drag the widget to the dashboard. Click on a date range. (No need to expand the widget to enlarge.) Once the billing report opens, view each patient, their claim details including visit and medication data. Click printer icon to print.
  • To expand each section, click the triangle at the beginning of the section (such as next to ‘Start Date below):
    
  • Expanding allows biller to view all visits and meds on the claim.
  • Click the “printer icon” to print the report.
• Claims Management—Use this widget to view claims that are “Not Sent” to ensure that all are ‘ready” or have a valid reason for being “not ready”.
  • Set any manual holds as necessary
  • Clear any “Errors”. Click on the word “Error” to see what the error is. Most errors will be cleared by entering missing data in the PATIENT module

Billing Via Claims Management Widget

Throughout the month, manage/submit NOEs using the Claims Management Widget.

1. Drag the widget to the dashboard.
2. Click on title to open to full size. See various tabs.
3. Status of “live claims” will display in RED
   

NOEs

Once a patient with Medicare as insurance and an admission date has been entered into the patient’s file, a listing will show under the NOE tab. The NOE status will show “error”, “Ready”, “Processed”, or “Submitted (with date)”. If the status is “error”, the missing information will be obvious (i.e. missing from the line of information) or clicking “error” will inform user of what information is missing. Click “refresh” (from gear) after entering missing information; this will clear the error.

If user’s DDE credentials have expired, a warning will pop up. Go to ADMIN/Persons/DDE Credentials and enter new password. One person’s DDE credentials are also stored in ADMIN/Billing & Financial/Medicare Intermediaries. It must also be kept up-to-date.

HINT: Watch the “New Admissions” widget to help identify new admissions and ensure that patient data is entered in a timely fashion to prevent late NOEs.

NOEs must be entered manually into DDE until ‘live DDE calls” is turned on. Once entered manually into DDE, click on “Ready” and change status to “Sent”. If SOC is turned on, the program will begin to import status. The NOE status will change from “sent” to “pending” to “paid” with a date.

If “Live DDE Calls” is turned on: If all information required for NOE submission is entered into patient’s file, the NOE will show as “READY”. Click the gear and “Submit NOE”. After confirming that the claim is ready to submit, it will be sent to DDE automatically. Watch daily for status to ensure that it is not rejected.

Whether submitted manually or automatically, status of the NOE will be continuously imported from DDE (if LIVE DDE CALLS is turned on). Watch the status to ensure that NOEs are being accepted in a timely manner.

At any time, if necessary, biller can choose “hand-keyed” and enter date of submission. Biller can modify “submitted” date as well.

Adding KX Modifier: If an NOE was submitted late and biller wants to appeal, click the “Submit Date”, answer Yes to KX, and enter the reason that the NOE was late. Claim will kick out as an ADR so that biller can submit proof per FI requirement.

NOTRs: should be done manually through DDE, outside of PIM and/or by submitting the patient’s final claim (make sure all visits are closed and medications have been uploaded).

Planned Feature: NOTR tabs: Once a discharge code of “live” discharge has been entered into patient’s file, the NOTR claim will show under the NOTR tab.

Pre-Bill

Throughout the current month, click on Pre-Bill tab to view a list of claims with errors.

• First go to “Not Sent”.
• Click “Refresh Claims”. Enter current month, (NOTE that the default is the current BILLING month which is the last full month); leave all other fields blank. Click OK.
• On the PreBill tab, biller will see any claims having errors. Click on “Error” to see the error. These error claims will also display on the “Claims Errors” portion of the Patient Drawer and the tab (within patient file) called “Claims Errors”.
• Claims that do not show on the “PreBill Tab” are complete/ready. Only claims with errors will display. 

Beginning of Each New Month

NOT SENT Tab

On the first day of a new month, create new hospice claims by using “Refresh Claims” button (see below).

View all claims that have not been sent from previous months, that are “ready” for current month, or that are not ready (“ERROR” displays in status field). Click “ERROR” to see what needs to be added/changed within the claim to make it “ready”.

Three buttons are available on the “Not Sent” tab. Clicking any of the buttons results in a window with the same fields:

• Month/Year defaults to current BILLING month (ie the most recent full month). For payers other than Medicare, partial month can be entered.
• Choose Payer Type.
• Choose Program.
• If “Patient” is left blank ALL patients will be included. Begin typing to choose a particular patient.
• Export options: Print claims to view or create paper claims; EMC if biller needs an EMC file for submission. PreBill to generate a PreBill Report.

Download Claims

Allows biller to download a single claim or a batch of claims. Choose “Option” of EMC or Print Claims. Open print claims in “Word”. A macro is available for putting claim in 1500 or UB format enabling biller to print out and mail claim if desired. Formats available are:

• Medicare (EMC or Print)
• Medicaid (EMC or Print)
• Commercial (print only)
• Non-Funded (print only)
• Self-Pay (print only)

Under “Downloads” is an additional “Option” called PreBill Report. This document allows user to view claims, including staff visits and medications. Textpad must be available to open this report in a readable format. Download at textpad.com.

Refresh Claims: allows biller to create/update claim(s).

• Use to create claims on the first day of a new month
• Use to create an old claim so that a recent payment can be posted
• Use to create claim errors for PreBill tab (use current month vs current billing month)
• Use to create a claim for current month for a discharged patient
• Use to update a claim to clear an error (after the missing info has been entered)

Submit: allows biller to submit claims.

Clicking submit will cause any “ready” claims to be electronically submitted. Any claim in status “Not Ready/Error” or having a manual hold will remain on the “Not Sent” tab. NOTE: the setting for “Enable Live Billing” must be turned on in ADMIN/Site.

Biller will get “Confirmation” message:

Once claims are submitted, the claims will be seen under the “Outstanding” tab with a status of “Sent”.

OUTSTANDING Tab: View all claims that have been billed and have an outstanding balance. NOTE: Once a claim is paid in full, it will NOT show on the “Outstanding” list by default. If biller has a need to see all claims (even those with 0.00 balance), enter the patient’s name in the grid. All claims for the patient will display.

Claim status for Medicare claims will be continuously imported. Claim status mirror DDE:

• PENDING:  DDE Status = “S”
• DENIED:  DDE Status = “D”
• RETRND: DDE Status = “T”
• INACTV: DDE Status = “I”
• RJECTED: DDE Status e = “R”
• PAYFLR: DDE Status = “P”
• PAID: DDE Status = “P” with an actual paid date and EFT Number

Claims will display the Status Category:

By clicking gear at the end of any row, the biller has the ability to bill secondary view details of AR transactions, and view billing report for a particular patient.

Medicare payment (835) will be imported automatically and amount of payment entered, as well as any automatic write-offs. Payments will display in the Remit Widget. (See below). Balances will remain of any amount not paid or auto-written off. Use gear to enter adjustment, bill secondary, etc. Payments from other sources will need to be entered manually.

RTPs: View all claims that go into RTP status once they reach DDE.

AMEND: When new information is entered into PIM that affects the claim AND the claim has already been submitted, a new claim will show on the “Amend” tab.

When additional data is entered after a claim is created, the claim will be tagged as needs review, and the program will handle the change as follows:

If original claim has not been sent and the books are open: program will simply discard the original claim and post a new one.

If original claim has not been sent and the books are closed: program will simply write off the original claim and post a new one.

If original claim has been sent: program will mark the original claim as needs amendment, and it will be on the AMEND tab. The biller will have the option to see what is different between the original claim that was sent and the new one and decide whether to submit/post the amended claim or leave the original as is.

Biller can see “Revenue” changes and the $$ amount involved. Biller can see “Non Revenue” (such as staff visits and medications) changes and the $$ amount.

Under the gear (on AMEND tab), biller will have the options to “See Original Claim Billing Report”, “Amend Claim” or to “Do Not Amend”.

For example, after submitting claims, a physician visit is entered late. This will cause a new claim to land under “Amend”. Biller will decide to submit an amended claim or not.

If claim is not to be amended, choosing “Don’t Amend Claim” will cause the claim to be removed from the grid.

Choosing “Amend Claim” will open a window complete with DCN and other claim information. Click “D1 Change Charges” to use another Condition Code. Note that, if claim has not yet paid, the DCN and payment amounts will be blank.

Click “Submit now” and OK to send claim. Clicking OK (without clicking “Submit now”) will cause claim to show on the Not Sent tab.

Batch Summary Widget

From the HOME screen, drag the Batch Claims Submission Widget out to HOME page. NOTE: this widget will not be available except to workers having roles within the Financial Role group. This widget will keep biller informed of the status of each batch submitted as well as each claim within the batch.

Before it is expanded, the widget displays the last several batches that have been submitted (see above), including submission date, payer, dollar amount, and number of claims within the batch. In “Summary” form, Date, Payer and Status are filterable.

Click the words “BATCH SUMMARY” to expand the widget to full size.

Biller can now see more details about the batch, including who submitted it, date, number of claims within the batch, total $$ amount, and “Status”.

The “Status” column pulls information from the 999/997 as to whether the batch was accepted or rejected. In the example above, the M/C batch submitted on 3/21 was ‘rejected”. If the batch was “accepted”, biller will be able to see the number of claims within the batch that were accepted, and/or had errors. This information is imported from the 277.

Each batch has a gear which allows biller to view “Claim Listing” or “999”.

Clicking the gear and choosing “Claim Listing” allows biller to see:

Batch summary (Batch Key, Total Amount of claims within the batch, date of submission, who submitted, payer and status) all in the header.

Each claim within the batch lists, along with amount, program, and status. Note that the “status” information will continue to change as the claim gets accepted, hits payment floor, and gets paid. Payments and adjustments will display as well.

Each individual claim will have a gear:

Revenue Details: Same as from the Claim Management Widget. Displays all revenue codes, claim amount, billing date, payment date, etc.

Billing Report: Same as from the Claim Management Widget. View of the claim details.

Claim Status History: Displays details of each step of claims submission (Read more below).

Hole Claim: ability to place a claim on hold from this widget as well as from CMW.

Claim Status History

This option under the gear for individual claims is available on the Claims Management Widget and the Batch Claims Submission Widget.

Choosing “Claim Status History” for a claim will display the history of the claim.

In the example above, the biller could see that on 3/22, Jeff created the claim, and on 3/29, this claim was SENT. Other claim histories that would display are REJECTED, PAID, HOLD, RETURNED, DENIED, etc. For each status, the biller can see the date, time, worder, and status.

Remit Summary Widget

Drag the Remit Summary Widget out to dashboard from the widget drawer. This widget will display all 835/Remits imported into the program. A green checkmark indicates that the import was successful.

While the widget is collapsed, click on a line item. Details float will open. Details about the payments can be seen.

To view details of an individual payment, click the Claim Key. The Revenue Details will open showing all payments, adjustments, and check details. Note that the Revenue Details are also viewable on the Claims Management Widget and the Batch Detail Widget under the gear of individual claims.

Close Books

In top right corner of Claims Management Widget is the “Close Books” field in which biller can enter a date through which all accounting records have been posted.

Once a date has been entered, HB will not accept dates prior to this date for fields that may affect accounting records (such as date a payment is posted, date that a claim was “sent”, etc.)

To Close Books:

• Submit all READY claims
• Post all payments received for the month
• Choose the month/year from the drop-down.
  

Once the books are closed for a month, any additional claims or payments must have a posted date AFTER the books-closed date. Closing the books will prevent the AR reports from changing even when patient data changes and/or claims are amended.

Accounts Receivable

NOTE: the financial widgets, such as Billing Report and Claims Management float, and the Financial Reports (such as AR Reconciliation) are ONLY available to anyone having a role listed under “Finance”.

• Claims Management widget—until such time as a claim has a zero balance, the claim will show on the Claims Management widget’s “Outstanding” tab. Use the gear to bill secondary, write off, enter an adjustment or post a payment. Use the “bubble” to enter a comment about why a claim has not paid and/or collection activities.
• Reports—in the REPORTS module, there are several reports relating to receivables.
  • AR Aging–Select “group by’ choice; select month (if current month is December and you last billed in December for November DOS, choosing December would show November claims in column “current”), base on “posted date” or “DOS”, and program.
  • AR Aging Claim –Similar to the AR Aging, this report breaks the aging down by claim detail.
  • Credit Claim Balance—Provides a list of accounts with an over-payment (ie a credit balance)
  • Month End AR Reconciliation—provides information for each patient with a starting balance, revenue entered, payments received, and ending balance for a time period.
  • Monthly Revenue—provides a summary of all revenue received for a time period broken down by revenue code and payer type.
  • Payments and Adjustments—a detailed listing of all payments received and adjustments entered for a time period.