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.