ADL DATA SYSTEMS, INC.
-
Upload
naida-giles -
Category
Documents
-
view
29 -
download
2
description
Transcript of ADL DATA SYSTEMS, INC.
11
ADL DATA SYSTEMS, ADL DATA SYSTEMS, INC.INC.
BILLING ADJUSTMENTSBILLING ADJUSTMENTS September 10, 2009September 10, 2009
TRANSACTION TRANSACTION ADJUSTMENTSADJUSTMENTS
Presented by Sara Montoro
33
Adjustments covered:Adjustments covered:
Days BilledDays Billed Patient Liability AdjustmentsPatient Liability Adjustments MedicareMedicare Co Insurance DaysCo Insurance Days Part B Cross-Over ChargesPart B Cross-Over Charges
44
DAYSDAYS 1. Incorrect Discharge Date. 1. Incorrect Discharge Date. Discharged and billed thru : 4/09/08 Discharged and billed thru : 4/09/08 Correct discharge Date: 4/06/08 Correct discharge Date: 4/06/08 Billing is over 4 Billing is over 4
daysdays
55
Correction Process:Correction Process:
* Use Option A – Hand Bill/Void/Transfer* Use Option A – Hand Bill/Void/Transfer
* Enter From and Thru Dates* Enter From and Thru Dates
* Select Paysource and click OK* Select Paysource and click OK
* Verify the Net Bill amount and click OK* Verify the Net Bill amount and click OK
66
* Review the Ledger* Review the Ledger* Create a R&B Ancillary batch to offset the incorrect days displayed * Create a R&B Ancillary batch to offset the incorrect days displayed
as unbilled and enter the correct number of daysas unbilled and enter the correct number of days
77
Note: Note: Medicaid Claims that have already been submitted are adjusted in the Re-Billing fileMedicaid Claims that have already been submitted are adjusted in the Re-Billing file
* Run the Billing process
88
2. Incorrect Admission Date. 2. Incorrect Admission Date. Admitted and billed thru: 4/25/08 – 4/30/08Admitted and billed thru: 4/25/08 – 4/30/08 Correct admission date: 4/24/08Correct admission date: 4/24/08 Billing short 1 dayBilling short 1 day
99
Correction process:Correction process:* Void days already billed using Option A * Void days already billed using Option A * Enter From and Thru Dates* Enter From and Thru Dates* Select Paysource to void and click OK* Select Paysource to void and click OK* Verify the Net Bill amount and click OK* Verify the Net Bill amount and click OK* Create a R&B Ancillary charge for missing days* Create a R&B Ancillary charge for missing days* Run billing process* Run billing process
1010
* Review the ledger
1111
Patient LiabilityPatient Liability
3. Billed incorrect Liability Amount 3. Billed incorrect Liability Amount
1212
Correction process:Correction process: * Select Option K – * Select Option K – NAMI/Budget bill adjustment NAMI/Budget bill adjustment and click OKand click OK * Enter the amount billed in the Budget field* Enter the amount billed in the Budget field * Enter the correct amount in the NAMI Bill field and click OK* Enter the correct amount in the NAMI Bill field and click OK
1313
* Review the Ledger* Review the Ledger* Verify the Expected Income & Budget screen and History fields * Verify the Expected Income & Budget screen and History fields for the correct liability amountsfor the correct liability amounts
1414
44. Billing without Patient Liability Amount. Billing without Patient Liability Amount
1515
I. Correction process:I. Correction process:* Select Option K – NAMI/Budget Bill Adjustment* Select Option K – NAMI/Budget Bill Adjustment
* Enter Liability Amount in the BUDGET field* Enter Liability Amount in the BUDGET field
* Verify the Net Bill Amount and click OK* Verify the Net Bill Amount and click OK
1616
( Retro Billing to capture all liability amounts missing from a Billing Cycle )( Retro Billing to capture all liability amounts missing from a Billing Cycle )
* Review the ledger
1717
II. Retro billing process:II. Retro billing process:* Select the Medicaid tab* Select the Medicaid tab* Select option 8 - MCAID Retro Billing * Select option 8 - MCAID Retro Billing * Enter the “last date” of the billing, enter the number of * Enter the “last date” of the billing, enter the number of
days days * Select Bill Budgets F option* Select Bill Budgets F option* In Paysources to include remove – * In Paysources to include remove – if Pending Medicaid if Pending Medicaid
claims were not includedclaims were not included, click OK, click OK** Select option 2- Sales Journal and click OK Select option 2- Sales Journal and click OK The Sales Journal report will displays all missing patient The Sales Journal report will displays all missing patient
liability amounts liability amounts
1818
* * Select option 10 – Post bills to ledgers Select option 10 – Post bills to ledgers * Enter Posting Date, Period Ending Date, check Medicaid, Retro and click OK* Enter Posting Date, Period Ending Date, check Medicaid, Retro and click OK* Review ledgers* Review ledgers
1919
MEDICAREMEDICARE
5. Billed Medicare due to incorrect cut off date. 5. Billed Medicare due to incorrect cut off date. Billed 9 days to Medicare + Co-days to privateBilled 9 days to Medicare + Co-days to private Medicare cut off date 4/01/2008Medicare cut off date 4/01/2008
2020
Correction process:Correction process:* * Use Option AUse Option A* Void Medicare * Void Medicare (paysource E)(paysource E) * Transfer Co-Ins from Private * Transfer Co-Ins from Private (paysource F)(paysource F) to Medicare to Medicare (paysource E or any (paysource E or any
other paysource billed as co-ins)other paysource billed as co-ins)**Verify Medicare Paysource screen Co-Ins Code and correct the End DateVerify Medicare Paysource screen Co-Ins Code and correct the End Date
2121
* Review the ledger
2222
6. Billed Medicare instead of Medicaid6. Billed Medicare instead of Medicaid
2323
Correction Process:Correction Process:* * Use Option A to Void Medicare – EUse Option A to Void Medicare – E* Enter from and Thru dates* Enter from and Thru dates* Select Medicare paysource* Select Medicare paysource* * Verify that the Net Bill matches the Ledger AmountVerify that the Net Bill matches the Ledger Amount* Verify the Medicare Paysource screen has the correct * Verify the Medicare Paysource screen has the correct
End DateEnd Date
2424
* View ledger* View ledger
2525
7. Billed wrong RUG Scores to Medicare 7. Billed wrong RUG Scores to Medicare
2626
Correction Process:Correction Process:* Review Transactions posted* Review Transactions posted* * Use Option A to void Medicare and bill Medicare Co-DaysUse Option A to void Medicare and bill Medicare Co-Days* Verify the Net Bill amount to the Ledger on both screens * Verify the Net Bill amount to the Ledger on both screens * Edit MDS Tracking and Bill * Edit MDS Tracking and Bill
2727
* Review the ledger* Review the ledger
2828
Co-InsuranceCo-Insurance
8. Billed Six Co-Days instead of 26 Co-Days8. Billed Six Co-Days instead of 26 Co-Days
2929
Correction Process:Correction Process:* Use Option A to create missing Medicare Co-Days* Use Option A to create missing Medicare Co-Days
* Enter From and Thru Dates* Enter From and Thru Dates
* Select Paysource in Co-Insurance field and click ok* Select Paysource in Co-Insurance field and click ok
* Enter co-days missing, rate, verify net bill * Enter co-days missing, rate, verify net bill
3030
* Review the ledger* Review the ledger* Correct the claim in Omni Pro* Correct the claim in Omni Pro
3131
9. Billed Co-Days to Insurance instead of Medicaid9. Billed Co-Days to Insurance instead of Medicaid
3232
Correction process:Correction process:* Use Option A to void Co-Day Paysource* Use Option A to void Co-Day Paysource
* Enter From and Thru Dates* Enter From and Thru Dates
* Select Paysource (L) in Coinsurance field and click ok* Select Paysource (L) in Coinsurance field and click ok
* Enter co-ins days, rate and Tab to amount field* Enter co-ins days, rate and Tab to amount field
* Verify that the Net Billed matches the Ledger Amount* Verify that the Net Billed matches the Ledger Amount
3333
* Review Special Data – Unbilled Days screen* Review Special Data – Unbilled Days screen* Review the Ledger * Review the Ledger * Verify the Paysource set up screen and bill Medicaid* Verify the Paysource set up screen and bill Medicaid
3434
PART B CROSS OVER CHARGESPART B CROSS OVER CHARGES
10. Billed Part B and Cross Over when resident had no Part B10. Billed Part B and Cross Over when resident had no Part B
3535
I. Part B correction process:I. Part B correction process:* Use Option A to void Part B Charges* Use Option A to void Part B Charges* Enter From and Thru Dates* Enter From and Thru Dates* Select T for Part B and click OK* Select T for Part B and click OK* Verify the Net Bill to the Ledger Part B Amount and click * Verify the Net Bill to the Ledger Part B Amount and click
OKOK
3636
II. Cross over correction:II. Cross over correction:* Use Option A to void cross over amount billed to private* Use Option A to void cross over amount billed to private* Enter From and Thru Dates* Enter From and Thru Dates* Select the Paysource Code used for Cross-over and click * Select the Paysource Code used for Cross-over and click
OKOK* Verify the Net Bill to the Ledger Cross-Over Amount * Verify the Net Bill to the Ledger Cross-Over Amount (Delete any other charges not related to this adjustment. (Delete any other charges not related to this adjustment.
Ex: R&B, etc.)Ex: R&B, etc.)
3737
* View the Ledger* View the Ledger* Remove the Part B flag from the Paysources screen* Remove the Part B flag from the Paysources screen
3838
Reports that help you identify accounts that Reports that help you identify accounts that may need Adjustments:may need Adjustments:
1.1. A/R Schedules Report - review file Name PTBALL reports A/R Schedules Report - review file Name PTBALL reports for Unbilledfor Unbilled
Charges.Charges.
2. 2. Ledger for the Month - review file name PTLSUM for all Ledger for the Month - review file name PTLSUM for all UnbalancedUnbalanced
Accounts displaying an Accounts displaying an **..
3. Print Registry - with the option NONE for the field selected to 3. Print Registry - with the option NONE for the field selected to include include Billed Charges to view any missed Unbilled Charges.Billed Charges to view any missed Unbilled Charges.
3939
End of PresentationEnd of Presentation
Thank you. Thank you.