Click here for downloadable PDF.

INDEX

1. Set-Up
   1. ADMIN/People and Places
      1. Sites
      2. Roles
      3. Facilities
      4. ClearPay
   2. ADMIN/Billing and Financial
      1. Adjustment Reasons
      2. Election Definition
      3. Insurance Carriers
      4. Physician Services
      5. Medicare Intermediaries
   3. ADMIN/Persons
2. Pre-Bill Process
   1. Financial Widgets
   2. Reports
3. Preparing and Submitting Claims
   1. ClearPay vs No ClearPay Grid
   2. Billing via HB
      1. Claims Mgt Widget Overview
      2. Notice of Elections (NOE) and Termination/Revocation (NOTR) Management
         1. Appealing a Late NOE
         2. Submission and Tracking NOES with ClearPay
         3. Submission and Tracking NOES without ClearPay
         4. Submission and Tracking NOTRS with ClearPay
         5. Submission and Tracking NOTRS without ClearPay
         6. Canceling NOE (Type of Bill 81D)
      3. Claim Options
      4. Beginning of the Month
      5. Preparing for Claims Submission
      6. Pre-Bill Report
      7. Submit Claims
      8. Batch Summary Widget
      9. Claim Status Legend
   3. Amending Claims
   4. Canceling Claims
   5. Room and Board Billing
   6. Medical Provider Services Billing
   7. Palliative Care Billing
   8. Secondary Payer Claims
4. Payments and Adjustments
   1. Medicare Electronic Remits (835)
   2. Printing Medicare Electronic Remittance Advice (835)
   3. Manual Payments and Adjustments
5. Month-End Close
6. Accounts Receivable

A. Set-Up

1. ADMIN Module: People and Places

1. Sites – mumms Liaison will ensure each site is set up with the proper NPI, billing address, and other information necessary for claims submission and will Enable Live Billing. See “Admin Module” instructions for more information.
2. Roles – Ensure that billing rates have been entered for all billable/reportable roles.
3. Facilities – Ensure that ‘Bill for R&B’ is checked for each facility in which there is a potential for billing R&B for a Medicaid recipient. Make sure facilities have a valid zip code +4 entered.
4. Enable ClearPay – If applicable, a mumms Liaison will enable and notify of any remaining set-up needed by the site.

2. ADMIN Module: Billing and Financial

1. Adjustment Reasons—should be created/entered to meet agency needs, in order to adjust balances off the A/R; such as Bad Debt W/O. Medicare Adjustment reasons get created directly from the Medicare Electronic Remittance Advice (Medicare ERA 835).

• • Note: Medicare Adjustment Reason Codes are directly from the Claim Adjustment Reason Codes (CARC), http://www.wpc-edi.com/reference/, ASC X12 assists several organizations in the maintenance and distribution of code lists external to the X12 family of standards. The lists are maintained by the Centers for Medicare and Medicaid Services (CMS), The National Uniform Claim Committee (NUCC), and committees that meet during standing X12 meetings.

1. Hospice Election Definition—The Medicare election/recertification rules will be used as the default for each carrier as every insurance carrier will need a Hospice Election Definition. Sites can set their own hospice election definitions for carrier types if they differ from the defaulted Medicare elections.
2. Insurance Carriers—choose from the list of ZirMed providers.
   1. Rates & Codes Tab: Ensure each carrier’s contracted rates are set.

Note: If contracted rates are not entered, the rates default to Medicare CBSA rates.

1. 1. 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).
   2. Discharge Day Billing Rules Tab: set up for each carrier. The default is Medicare settings.

1. Physician Services Favorite—set a ‘favorite’ list of physician billing codes as well as desired billing rates, if billed at agency rates and not Medicare Fee Schedule.

Note: Codes and rates are uploaded from CMS quarterly.

1. Medicare Intermediaries—need to be addressed to identify site-specific Medicare Fiscal Intermediary. If ClearPay Enabled, DDE Credentials need to be entered, updated, and maintained by the site.

3. ADMIN Module: Persons

1. For ClearPay Enabled any user accessing Medicare Eligibility or submitting NOEs will need to have their own DDE Credentials. DDE Credentials will need to be entered into their PIM Persons detail AND updated each time the password is updated.
2. Billing and Accounting staff will need to have a ‘Role’ from within the Financial Role Group in order to access Financial Widgets and reports.

B. Pre-Bill Process

1. Financial Widgets: Widgets listed here will assist with the Billing & Pre-Billing Process.

• Claim Errors Patient Drawer—click Claim Errors (bottom 1/3 of the Patient drawer) to see the ‘Exceptions’ (error) list, including the cause of the “exception”. “Exceptions” are items that affect billing such as lack of complete certification, missing DOB, etc. Once on a patient, the Claim Error Tab will indicate all errors. Make any necessary corrections/updates. Go back to the Claim Error Tab to Refresh Claim, right from the patient’s record. Open Claim Errors Patient Drawer and select the next patient with errors and repeat. Note: To ensure that all exceptions are displaying, do this from the Claims Management Widget:

To create current month errors and/or refresh all errors:

• • Use the Refresh function in the Not Sent Tab of Claims Management Widget.

• • Change the date to the current month (not current billing month). This will generate all current month exceptions and place them on the Claims Error tab (in Patient Module-Patient Drawer).
  • You may also want/need to print the Exception Report in the PIM Report Module for the current month as necessary.

• Prior Authorizations—See a listing of any patient whose authorization is expiring/ed. See details under the Reports & Widgets section of the User Instructions.
• Billing Report—In addition to the Pre-Bill report, this widget allows the review of each claim prior to submitting it. 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 the printer icon to print if needed.
  • To expand each section, click the triangle at the beginning of the section (such as next to ‘Start Date below):

• • Expanding allows the biller to view all visits and meds on the claim.
  • Click the “printer icon” to print the report if needed.

• Claims Management—This is the working Billing and AR widget. By default, only claims with Non-zero balances are displayed. All claims for a patient will display when searching for a specific patient. 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.
• Rx Fills—Use this widget as a reminder for the medication upload, either to confirm that mumms has received your Rx File from your contracted pharmacy and automatically uploaded or to confirm the designated staff member has received the Rx File and manually uploaded.
• Interactions (Visits)—Use this widget view/review any staff interactions documented in the chart or manually entered; that may be in question.
• Batch Summary — Use this widget to follow submitted claim batches and/or download and print a submitted batch claim listing.

Note: Access to Financial widgets require a Financial Role assigned to the user’s Person detail.

2. Reports

At a minimum, the following reports should be reviewed prior to claims submission.

• Patient Days by Level of Care**—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 Days $$**—Check to ensure that correct billing rates and the 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.
• Pre-Bill Report—found in the Claim Management Widget > Not Sent tab > Downloads function. This report will show all billable days, revenue codes, visits & medications (M/C Claims only), R&B charges if applicable. Additionally, you can access an individual pre-bill report for an individual claim directly from the outstanding tab by choosing the gear to the right of the claim you want to view and selecting pre-bill.

C. Preparing and Submitting Claims

1. ClearPay vs. No ClearPay Grid

The steps needed for preparing, submitting, and tracking NOEs and claims will depend on whether or not you use hummingbird’s ClearPay feature. Below are the differences.

2. Billing Via Hummingbird PIM

a. Claims Management Widget (CMW) Overview

The Claims Management Widget on desktop will display a summary of claims, including sent, ready, on hold, etc.

Click the widget to expand and see the tabs (below):

Note: Status of ClearPay will display in the Claims Mgt Widget. Additionally, if the DDE password set up in ADMIN/Medicare Intermediaries expires, an alert will show in the CMW.

• OUTSTANDING Tab – By default, the grid displays a listing of all non-zero balance claims to scroll through. Will also display all claims, including those with a zero and the NOE (81A) by searching for a specific patient.
• NOT SENT Tab – This is a subset of all Outstanding claims that have not been sent including claims that are in ERROR, manual HOLD, SEQH, and READY statuses.
• Medicare Claims under the “Not Sent” tab include:
  • “Current billing month” (last full month) vs “Current month” (month as of today)
  • Discharge claims for the current month. Note: These claims automatically go to HOLD status until biller can verify that visits, meds, etc. are included and releases to READY.
• Submit Claims – This option is used to submit READY claims to Medicare and Zirmed. Claims can be submitted in a batch of all READY claims or for a single patient.
• Refresh Claims Function – Used to re-create / update claims and to update claims, including those already paid/processed.
• Download Claims Function – Used to print claims in a print claim format (not a print image), obtain the EMC file, and to print the Pre-Bill Report.
  • Note: Submit, Refresh, and Download functions contain selection criteria to indicate the program, payer type, date range, and patient(s). Downloading also provides an option to get the Pre-Bill report.

• • RTPS Tab – This is a subset of all Outstanding Medicare claims that have the status of Return to Provider Status (RTPS). A claim will display on the RTPS after it’s been submitted and accepted by Medicare, but Medicare has determined a correction is needed before further processing. Any claims that will need correcting are handled through DDE directly. Login to DDE outside of PIM, make any necessary claim corrections and send the claim through for processing.
  • NOES Tab – NOE Maintenance and tracking. (see below for details)
  • NOTRS Tab – NOTR Maintenance and tracking. (see below for details)
  • AMEND Tab – Claims will display on the AMEND Tab when there’s been a change to billing data for an already paid/processed claim; i.e. late visits, late medications, date of admission and/or date of death changes, level of care changes. Hummingbird list those claims as a suggestion that they may need to be amended. The user has the choice to amend or not amend, and once decided the claim will drop from this listing. When Refresh Claims function is completed, claims are updated and can include paid/processed claims which could require an amended claim. If so, those claims will be listed on the AMEND tab. (See more details below.)

b. Notice of Elections (NOEs) and Termination/Revocation (NOTR) Tabs

Admitted patients with Medicare coverage will populate on the Claim Management widget NOE Tab.

If the patient is showing with “Unknown” Payer, it is an indicator that coverage has not yet been identified for the patient and this needs to be addressed in the patient’s record. Note: The Recent Admits Widget helps identify new admissions and ensure that patient data is entered in a timely fashion to prevent late NOEs.

If the NOE status is ERROR, click the status to reveal the error(s).

Once the errors are corrected, select the gear to the right of the line item, and REFRESH. If there are no further errors, the NOE will refresh, and the status will change to READY.

Note: Non-ClearPay clients will hand-key NOEs into DDE. ClearPay clients’ NOEs will be electronically submitted to DDE.

i. Appealing a Late NOE

If the submitted date is “late” the program will prompt to see if the user wants to appeal the late NOE and include the KX modifier and a reason.

• • Select the gear to the right of the line item.
  • Select Submit NOE or Hand-keyed.
  • Submission Float opens.

• • Select Yes for Add Late Submission Reason and enter the reason in Late Submission Reason text box (the reason will appear in Remarks Field of UB04).

For late days the Pre-Bill report will show NC (no coverage) next to each day’s revenue line.

ii. Submission and Tracking NOES with ClearPay Enabled

• • Select the gear to the right of the line item.
  • Select “Submit NOE”.
  • A float will open displaying the current date which represents the submission date; select OK.
  • A confirmation float will open asking the user to confirm the Live NOE should be submitted directly to DDE; select OK.
  • The status of the NOE will change to SENT.
  • With ClearPay Enabled, PIM will begin tracking the NOE and, in a day, or two the status will update from SENT to PENDING to PAID.

Important: When just beginning to use the PIM system, log in to DDE outside of PIM to confirm the NOEs were received and are going through the process.

Notice: Remember to check the NOE status regularly from the CMW to ensure all are being processed accordingly. If a status has not updated, login to DDE outside of PIM to see if Medicare needs additional information and/or has additional information for that Medicare recipient.

iii. Submission and Tracking NOES without ClearPay Enabled

• • NOEs must be entered manually into DDE.
  • Login to DDE outside of PIM.
  • Manually enter each NOE into DDE.
  • In PIM CMW, enter date NOE was manually entered into DDE.
    • Claims Management Widget > NOE Tab > select the gear to the right of the line item > select Hand-Keyed.
    • Submission Float opens > enter date manually entered into DDE.
    • NOE Status updates to SENT.
  • Manually update NOE Status from DDE.
    • Login to DDE outside of PIM.
    • Check the status of NOEs; if finalized in DDE, update status in PIM
      • Claims Management Widget > NOE Tab > click on SENT Status > select PAID

Important: NOE maintenance must be done to avoid an automatic sequential hold (SEQH) of the patient’s first claim.

Note: The hand-keyed date of submission can be changed by clicking on the date. The Submission Float opens, and changes can be made.

iv. Submission and Tracking NOTRS with ClearPay Enabled

Claims for Medicare patients discharged in the current month will land under the NOTRS tab.

• • If the claim is READY (and meds have been uploaded and all visits entered), submit the claim. (Medicare prefers this method.) Note: Claim will be submitted via the ‘Not Sent” tab. Once submitted, the claim will no longer display on the NOTR tab.
  • If the claim is not ready, use the gear to choose “Generate and Submit NOTR”.

• • Once submitted, the status of the claim will display.

v. Submission and Tracking NOTRS without ClearPay Enabled

• • If the claim is READY (and meds have been uploaded and all visits entered), submit the claim. (Medicare prefers this method.) NOTE: Claim will be submitted via the ‘Not Sent” tab. Once submitted, the claim will no longer display on the NOTR tab.
  • If the claim is not ready, hand-key NOTR into DDE.

vi. Canceling NOE (Type of Bill 81D)

You can find the Cancel NOE option from the PIM > Claims Management > NOE > gear menu for any NOE (81A or 81C) in PAID status.

You will then see a pop-up prompt to confirm the cancel NOE and submit.

Note: NOE’s must be canceled sequentially, just as NOE’s and claims must be submitted sequentially. If the patient selected has any claims sent after the NOE, you will receive an error message and the cancel NOE process is stopped:

You will also receive an error notice if an 81D already exists in PIM > Claims Management > Outstanding tab for this NOE:

If no sequential claims have been submitted, or all sequential claims have already been canceled for the admission, you will receive the following confirmation:

You can then find both the original 81A and the new 81D records from the Claims Management > Outstanding tab listing:

To submit a new NOE after a canceled NOE in PIM, please contact PIM Support using the Report a Problem button. This functionality is in progress for a future release of the program but is not automated in PIM at this time.

c. Claim Options

Claims have various options available under the gear to the right of each claim, throughout the Claims Management Widget and other Widgets. Options available are different depending on the tab, the status of the claim, and the widget.

  From “NOT SENT” tab:                        From “OUTSTANDING” tab:

Claim Details – Displays claim amount, billing date, payment date. Details incoming revenue and codes from 835 (when using ClearPay).  

Billing Report – View of the claim details, including the services included on the claim that are not posted to the AR, such as visits and medication fills.

Claim Status History – Accessing the Claim’s Status History will display the detailed history of the claim, from initial creation, submission, and the various statuses of processing, until it hits the pay floor and paid. Details include the date, time, status, and the user.

Manually Sent—Used to change a READY claim to SENT when the claim has been manually sent from outside of the program.

Theoretical SIA—SIA payments do not display on a claim; however, the program will calculate and report SIA using this gear. SIA payments are seen on A/R reports.

Hold Claim/Release Hold—Used to place a manual hold on a claim, including the reason for the hold. Also used to release the claim for billing.

Delete Claim—Used to delete a claim. NOTE: Claims can only be deleted based on the books closed date and if NOT SENT.

Add Payment/Adjustment—Manually post payments and/or adjustments.

Refresh—Manually refresh a claim. Note that the program systematically refreshes claims daily.

d. Beginning of the Month

Create current billing month claims: Current Billing Month claims are created in the early morning on the 1^st day of the month or by using the REFRESH function in the NOT SENT Tab.

e. Preparing for Claims Submission

Complete the Pre-Bill Process (outlined above) to check claims.

For any READY claims which should not be submitted, place on a “Manual Hold”. To do this:

• • Access the NOT SENT Tab.
  • Click the gear to the right of the claim line item.
  • Select Hold Claim from the menu of options. A Hold Reason float will open with a text box. A reason is required.

f. Pre-Bill Report: Download current billing Pre-Bill Report

• • Go to NOT SENT Tab
  • Click “Download”
  • Select the option “Pre-Bill” (click on EMC to view drop-down)
  • Repeat for each payer and/or Program.
  • Review the Pre-Bill Report and confirm visits, medications, Room and Board Billing, SIA, etc.
  • Note: Pre-Bill Report is available in text format or CSV (Excel).

g. Submit Claims

Submit claims by using the Submit function in the NOT SENT Tab. This will need to be done for each payer and Program when billing for Hospice and Palliative Care. Submissions are batches, regardless of the number of claims being submitted.

                  Medicare claims > submitted to Medicare through Ability

                  Medicaid claims > submitted to ZirMed, a billing clearinghouse

                  Commercial claims > submitted to ZirMed

                  Palliative Care claims (Medicare Part B, Commercial, etc.) > submitted to ZirMed

When selecting ‘Submit All READY Claims’, all claims for that Program and Payer Type with a READY status, regardless of the claim dates, will be included in the batch.

Leave the “Patient” field blank to include all READY claims within selected criteria or begin typing a patient’s name to create a single patient claim for submission.

A confirmation float will open to confirm claims submission.

Once claims are submitted, claim status will update to a status of SENT and move off the NOT SENT Tab to the OUTSTANDING Tab. The claim submission date will display. As Medicare claims process, their status will change if using ClearPay.

h. Batch Summary Widget

The claim(s) will also appear in a batch listing in the BATCH CLAIMS SUBMISSION Widget (BATCH SUMMARY) found on HOME page/Widget Drawer.

Batch Summary Widget Status Legend:

• Medicare=SENT

Will remain SENT until changed manually if not using ClearPay. If using ClearPay, status will change as the claim is accepted, processes, and pays.

• Commercial = SENT

After claim(s) submission, batch will populate with a SENT status and will always remain SENT. Access your ZirMed Account, outside of PIM and confirm/follow submitted claims.

• Medicaid = SENT

After claim(s) submission, batch will populate with a SENT status and will always remain SENT. Access your ZirMed Account, outside of PIM and confirm/follow submitted claims.

• BATCH SUMMARY Widget Collapsed (as above)
  • After claim(s) submission, status will show SENT.
  • Medicare Claims: Upon receipt of 999, batch will show status of ACCEPTED if using ClearPay
• BATCH SUMMARY Widget Expanded
  • View list of each batch submitted
  • Use gear to view list of claims within the batch and/or 999

• The list of claims can be downloaded using the “Download” button.
• Details of each claim can be viewed.
• Status of each Medicare claim will change as the M/C claim is accepted, processes and pays (If using ClearPay).

Without ClearPay:

You will need to retrieve the Medicare 999 Batch Acknowledgement Report(s) and the Medicare 277 Claim Acknowledgement Report from the Document Management System in PIM by selecting  icon in the top menu bar of PIM > selecting X12 > selecting each 277 and 999 save to your computer and put through the PC AcePro or PCPrint reader.

ClearPay Enabled Feature Batch Summary Legend:

Medicare

• SENT = After claim(s) submission, batch will populate with a SENT status.
• ACCEPTED = mumms has received and imported the status of the accepted Medicare 999 Batch Acknowledgement Report(s) and updated the status of the claim(s) batch submission automatically.
• REJECTED = mumms has received and read the status of the rejected Medicare 999 Batch Acknowledgement Report(s) and updated the status of the claims(s) batch submission automatically.

After the Medicare 999 Batch Acknowledgement Report is received, access the submitted batch to confirm receipt of the Medicare 277 Claim Acknowledgement Report(s) by selecting the gear to the right of the batch line item and selecting Claim Listing. Each claim status will show a status other than SENT, such as PENDING, REJCTED, RETRND, and (eventually) PAID.

i. Claim Status Legend

READY = claim is ready for submission

HOLD = claim has been placed on a manual hold

ERROR = claim has an error. Details of errors can be found on the Exception Report in the Reports Module, Claim Errors Patient Draw, or by clicking on ERROR

SEQH = Sequential Hold, Medicare term

SENT = claim has been submitted

ClearPay Enabled Feature Claim Status & Code Legend:

PIM will display the Status Code descriptions.

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

Additionally, claim status codes can be reviewed/accessed through http://www.wpc-edi.com/reference/ and searching Claim Status Category Codes and the Claim Status Codes.

Contact EDI Support for further clarification, when necessary.

3. Amending Claims

Claims will display on the AMEND Tab when there’s been a change to an already paid/processed claim; i.e. late visits, late medications, date of admission and/or date of death changes, level of care changes. When Refresh Claims function is completed, claims are updated included paid/processed claims which could result in an amended claim.

 “Download Pre Bill” function (See above) from the AMEND Tab will populate a modified version of the Pre-Bill with only the claims eligible for amending. Note: If there are no eligible claims for amending it will populate the full monthly Pre-Bill Report.

The grid under “Amend” tab will show the dollar amount difference and whether the change was a “Revenue” change (Days of service, LOC, billable physician visit) or a “Non-Revenue” change (staff visits, medications).

Gear Options:

• Original Claim Billing Report
• New Claim Pre-Bill
• Amend Claim
• Don’t Amend Claim

If electing to Amend Claim, the program will write off the original claim and post a new claim with the changes after completing the necessary information in the Create an Amended Claim float. If electing Don’t Amend Claim the amended claim will be deleted and removed from the Amend Tab. The patient’s account will remain unchanged.

Submitting Amended Claim:

Click “Amend Claim” from under the gear. Float will open with details of the claim to be amended. Clicking “Submit Now” (see below) will result in electronic submission directly to Medicare for processing. If “Submit Now” is not checked, the new Amended claim will display in the “Not Sent” tab and will be included in the next batch.

Maintenance of the AMEND tab should be done regularly, otherwise claims will remain on the AMEND tab indefinitely.

4. Canceling Claims (Type of Bill 818)

You can also cancel Medicare claims with PAID/DENIED status and a $0 balance from the “Cancel Claims” option in the gear menu in the PIM > Claims Management > Outstanding screen.

The canceled claim process will require a DCN number (if not already populated from the original claim), and a D5 (Cancel to Correct Provider/HIC#) or D6 (Cancel Duplicate Payment) condition code. Remarks can be entered for the canceled claim but are not required.

When the required fields are completed, click OK to submit the 818 canceled claim, and you will receive a confirmation pop-up message.

You’ll then find both the SENT status 818 and the original PAID claim on the Outstanding tab:

When PIM receives the 835 remit file from Medicare for the 818, the 818 claim line updates to PAID status, and the original claim line updates to REPLACED status:

With the 818 finalized, you can create a refreshed copy of the original to submit again as needed. To create the new copy of the claim, go to Claims Management > NOT SENT > Refresh claims.

After refreshing the claim, it can be resubmitted at any time from Claims Management > NOT SENT > SUBMIT:

You can then find all 3 claim lines (original claim submission, 818 cancel claim submission, and the new copy of the original claim) from the Claims Management > Outstanding tab:

5. Room and Board Billing

Used to track and bill for services for traditional Medicaid Room and Board Billing and for non-hospice room and board services (such as rental of Inpatient rooms to another hospice) or for private pay residential care.

Room and Board Billing is set up by patient in Patient Info > Insurance Tab & LOC/Facility Tab. Payer source for R&B is set up under Patient Info > Insurance Tab. Bill for R & B must by checked. (See more information in the LOC/Facility Tab Tip Sheet.)

LOC/Facility Details must be completed accordingly.

R&B Claims will be created along with claims for hospice services and will show on the CMW.

Submitting R&B Claims:

Medicaid: Choose Payer, date range (program allows creating of partial month claims if your State allows). Leave patient name blank to include all R&B claims or begin typing a patient’s name to create one claim.

Click into the “Bill” field to choose “All” (both hospice and R&B claims for that Payer), or R&B Only or Hospice (claims) Only.

Click OK to submit claims to Zirmed.

For Private Pay R&B claims, use the “Download” option under “Not Sent” tab. Change “EMC” to “Print Claims”. Choose “R&B” under “Bill”.

6. Medical Provider Services Billing (Physician and NP Billable Visits)

Provider face to face visits are administrative visits and are not billable.

If a provider is doing a face to face visit, documentation for this type of visit should be completed on the following form:

• Face to Face Encounter form

The face to face encounter fate and provider will populate to the Insurance tab > Elections and the Physician Cert App when complete.

This is a non-billable visit type and will not populate to billing.

With use of Hummingbird Clinical (HBC) and/or Hummingbird Mobile (HBM or M2) to document billable provider services the billable visits will transfer to Hummingbird PIM automatically and will be ready for review and/or submission.

HBC/HBM best practice documentation contains the HCPCS/CPT billable codes and can be found in the Location and Type of Visit division > Symptom Management-use for billable visits option of the following forms:

• Medical Provider Visit Record
• Medical Provider SOAP Note

Without the use of Hummingbird Clinical (HBC) and/or Hummingbird Mobile (HBM or M2), Billable Medical Provider Service codes will need to be manually entered into PIM > Interactions.

Drag out the Interactions Widget onto the Home Dashboard from the Dashboard Widget Draw.

Open the Interactions Widget expanded float by clicking the mouse on the Widget title, “Interactions”.

On the ADD INTERACTIONS Tab enter the details of the billable visit including the required fields.

Once a billable Care Provider (such as physician or NP) has been selected a Physician Services float opens for entry of further details on the visit.

Is This Visit Billable?

Yes = Answer required questions, including billing code. Information will populate claim.

No = No further information needed.

HCPCS/CPT = pulls Codes, Description, and Rates from Medicare Physician Fee Schedule that is stored and updated quarterly in PIM.

Note: the rates that populate are the Medicare Fee Schedule. If rate is over-written, an IMPORTANT MESSAGE Float will open asking if you want the new rate to be saved as a favorite.

Modifier = Modifier for NP Visits are auto populated on the claim, don’t need to be entered here. Other types of modifiers can be entered here.

Location = Place where service was provided (auto-populates with patient’s location of care.)

Facility Type = if service was provided in a facility, type of facility should correspond

Related Diagnosis = ICD-10 diagnosis code or description can be entered, and selection made from the pre-populated listing. (This is a requirement for palliative care program visits. Patient would need to be in Program=PC.

After entering the additional details including the required fields, the + will turn blue, allowing for the visit details to be added.

After adding the additional billable visit details, the visit is now ready to be added to the patient’s visit history by selecting the blue + in the upper right of the visit entry.

After adding the billable visit, the visit details display below the grid and a green stethoscope displays next to the visit indicating a billable visit.

A gray stethoscope indicates a non-billable visit.

Medical Provider Services Claim Preparation

Hospice Claims: Billable physician and/or NP visits for hospice patients are included in the claim along with hospice service revenue. Billable physician and/or NP visits entered after the hospice claims has been created will cause an amended claim to be created.

Billable physician and/or NP visits for PC patients: See Palliative Care Billing (below).

7. Palliative Care Billing

This Requires Additional License – Please contact mumms Sales / Account Management for pricing and activation.

Using Hummingbird Clinical (HBC) and/or Hummingbird Mobile (HBM or M2) to document billable visits for Palliative Care patients will transfer the billing codes and corresponding ICD10 codes to PIM.

HBC/HBM best practice documentation contains the HCPCS/CPT billable Medical Provider Service codes and an ICD-10 Diagnosis Picker to select 1 – 4 ICD-10 codes and can be found in the Palliative Consult Workload and/or Billing division of the following forms:

• Palliative Care Consultation
• Palliative Care Psychosocial Evaluation
• Palliative Nurse Practitioner SOAP Note
• Palliative Physician SOAP Note

Without use of Hummingbird Clinical (HBC) and/or Hummingbird Mobile (HBM or M2) billable Medical Provider Services will need to be manually entered into PIM > Interactions. Follow same procedure found under the Medical Provider Services Billing Section (above).

8. Secondary Payer Claims

To bill a secondary insurance carrier, the patient must have each insurance entered and appropriately defined as primary and secondary in the patient’s record under the Insurance Tab.

Claim status should display PAID after primary insurance payment has been posted.

Select the gear to the right of the claim line item to select Bill Remaining Carrier.

D. Payments and Adjustments

1. Medicare Electronic Remittance Advice (835)

The Widget entitled “835” (in the home screen widget drawer) is where your Medicare Electronic Remittance Advice will be located. Once on the home screen the widget title displays as Remit Summary. Medicare payments will be received and posted automatically. Including any adjustments, such as the 2% Medicare Sequestration, SIA, etc.

Indicates successful payment posting of all claims paid in the Medicare Electronic Remittance Advice.

Indicates successful payment posting of some claims and some claims payments not posted because details are missing, possibly from a manually entered claim directly into DDE.

 Indicates unsuccessful payment posting for all claims paid in the Medicare Electronic Remittance Advice.

Click “View Expected” button to view the remits related to submitted M/C claims and their expected date of receipt along with the dollar amount of the expected remits. (Click “Remits” to return to the Remits Received view.)

To access the details of the remit, click on the line item within the Remits Received widget.

Click on the gear to the right of the line item to access the Check Posting Details for the claim. Click on the “Claim Key” to view the Revenue Details for a claim.

Note: As remits are posted, revenue, codes, write-offs, and other details are viewable within the CMW, the Batch Claim Widget, and the reports relating to AR.

2. Printing Medicare Electronic Remittance Advice (835)

Access to a paper/print copy of the Medicare Electronic Remittance Advice (835) will be in the Document Management System in PIM by selecting  icon in the top menu bar of PIM > selecting X12 > selecting 835 > save to your computer and put through the PCPrint or Medicare Remit Easy Print reader.

3. Manual Payments and Adjustments

Any payment and adjustment other than Medicare or those received in an 835 will need to be entered manually through the Claims Management Widget > OUTSTANDING Tab.

Select your patient to post against. > Click on the gear to the right and Select Record PROPORTIONAL Pay/Adjust or Record MANUAL Pay/Adjust.

Selecting Proportional, PIM will automatically post the payment proportionally across all revenue lines.

Selecting Manual will allow you to post directly to a specific revenue line.

Once selected, a floating window will open. The top left of the window will have the area to add your check number, check date and posting date. Posting date will default to today’s date. If you are moving between patients with the same payor, the check number and date will remain intact until you change it or close PIM.

When the check number and dates have been entered, click the checkmark to the right of the posted date.

A blue + will display to the right of the claim or revenue line. The top row displays the total amount of the claim. Subsequent rows display the revenue lines when applicable.

Choose the appropriate line on which to post the payment or adjustment.

When the check number and dates have been entered, click the checkmark to the right of the posted date.

The top row will represent the overall claim. Revenue lines will be listed below.

If posting proportionally, a blue checkmark will appear to the right of the claim row.

If posting manually, blue checkmarks will appear to the right of all revenue rows so you can choose the appropriate row to post against. Click the appropriate plus sign to post.

Posting of payments and adjustments can be added directly in the open row.  Clicking the plus sign again will allow additional posting to be added from the same check number.

Click the checkmark in the upper right to return to the Claims Management screen or the claims details button to see the claim totals, payments and adjustments.

Click checkmark to exit.

E. Month-End Close

Closing the books is done through the Claims Management Widget > Close Books field in the top right corner of the Claims Management expanded float.

Close Books Checklist:

• Refresh and/or Submit All Current Billing Month Claims.
• Post All Payments received in the Current Billing Month.
• Post All Adjustments.
• Close Books.

Once a date has been entered, the program will prohibit any further posting of revenue, payments or adjustments using a date which is prior to the Books Closed Date.

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 is highly recommended as it will prevent the AR reports from changing even when patient data changes and/or claims are amended. Such instances will be posted to the current open month.

F. Accounts Receivable

Reports—in the Reports module, there are a number of reports relating to receivables. Be sure and review the Reports menu as new reports are added frequently. Some of the most popular AR reports are:

• AR Aging
• AR Aging Claim—AR breakdown by claim detail.
• Credit Claim Balance—Provides a list of accounts with an over-payment.
• Month End AR Reconciliation—Provides information for each patient with a starting balance, revenue entered, payments received, and ending balance for a time period.
• Revenue Reports—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.