Keys to Success in the Billing World Presented by: Dottie J. Hauman, Revenue Cycle Consultant [email protected] Kelly J. Sorensen, Sr. Revenue Cycle Consultant.

2015 PCC Optimization Workshop

Keys to Success in the Billing World

Presented by: Dottie J. Hauman, Revenue Cycle Consultant

[email protected]

Kelly J. Sorensen, Sr. Revenue Cycle [email protected]

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Are you complying?

Are you having issues?

Are you experiencing pitfalls?

Let’s talk about it….

Copyright © 2015 HW&Co. All Rights Reserved.

No Pay Claims….

Go to A/R Configuration under Set-up and check the following boxes for automatic generation.

3Copyright © 2015 HW&Co. All Rights Reserved.

How-To Generate No Pay Claims in PCC


How to Set Up in PCC


No Pay Sample Claim

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• A good place to START would be in review of your current month’s census, during part A billing. Look for resident’s that were cut from skilled care and remained in your facility. PCC should generate these claims for you correctly.

• If you need to play catch-up, you are permitted to lump multiple months/years into one claim and submit to Medicare for processing.


No Pay claims-How would you start this process??

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A successfully processed No Pay claim will return with an “R” and code: 39934 (this is good !)

Most common rejections of No Pay claimsC7010-Overlaps Hospice election

15202-Number of Units Issue38020-Overlaps with IP Claim

38119-Out of sequence38117-Out of sequence

Are you seeing other rejections that you would like to discuss?

No Pay Claims – General Notes


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How long must I submit Benefits Exhaust Claims to Medicare? How will I know when to stop submitting Exhaust Claims? PCC generates Exhaust claims along with current Medicare A claims. Any issues with Exhaust Claims processing correctly? How are Exhaust Claims different than No Pay Claims?

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Benefits Exhaust Claims

References:CGS Quick Reference: www.cgsmedicare.com/parta/pubs/news/2013/0613/22579.htmlMLN Matters 4292 (10/24/12): www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM4292.pdf


http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM4292.pdf

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM4292.pdf

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Benefits Exhaust Claim Example


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Are these really necessary?

What is the best way to handle this task?

Is affixing Condition Code 04 my only coding requirement to comply on this task?

Only required for Part A Claims!

Don’t forget to submit Info Only claims for the skilled MyCare stays.

Make sure you have the Medicare HIC #

HMO Information Only Claims


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Don’t forget that you need a checkmark in the Insurance link screen to signify that a information only claim should be generated.


How to Set-up in PCC

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2015 PCC Opimization Workshop


HMO Information Claim Only Example

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What is an MSP, anyway? When do I send these claims? Will Medicare really pay?

CMS Guidelines and Resources for Medicare Secondary Payer:http://www.cgsmedicare.com/hhh/education/materials/MSPResources.html

CMS Billing & Adjustment Guide: (awesome tool)https://www.cgsmedicare.com/hhh/education/materials/pdf/MSP_Billing.pdf

Medicare MSP Questionnaire:

http://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/ProviderServices/Downloads/CMS-Questionnaire.pdf

Claim Adjustment Reason Codes: http://www.wpc-edi.com/reference/

Medicare Secondary Payer (MSP) Claims


http://www.cgsmedicare.com/hhh/education/materials/MSPResources.html



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When: October 1, 2015

• If you are an Ohio Medicaid Trading Partner, you should make plans to send some test claims to ensure that any issues are resolved before 10/1/2015.

• The process is fairly simple, and carries BIG benefits.

• The Ohio Department of Medicaid has an ICD-10 webpage at: http://medicaid.ohio.gov/PROVIDERS/Billing/ICD10.aspx.

• ICD-10 information such as Provider Q&A, trading partner testing, free coding practice for providers, OhioMHAS coding resources, and other documents and resources have been posted there.


http://medicaid.ohio.gov/PROVIDERS/Billing/ICD10.aspx

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• In PCC, the facility can begin to add new Diagnosis sheets containing ICD-10, for the October 1, 2015 starting date. No need to wait!

• On the PCC home page, there are training opportunities available.


ICD-10 : What to do now...

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Vaccination Billing Set-up Vaccine Payers for most efficient claim

processing.

Pneumococcal Vaccine Influenza Vaccine No More Roster Billing Quick turnaround of payment

Reduce the pain


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Vaccination Charge Code Setup



Create your New Payer and Add Your Template

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• Insurance claim status/eligibility: www.Availity.com• CGS Web Portal: www.cgsmedicare.com/mycgs/index.html• NPI Look-up Portal: https://nppes.cms.hhs.gov/NPPES/Welcome.do• MyCare Aetna Portal: https://medicaid.aetna.com• MyCare Buckeye Portal:

www.buckeyehealthplan.com/for-providers/providers• MyCare CareSource Portal: https://providerportal.caresource.com• MyCare Molina Portal: https://provider.molinahealthcare.com• MyCare UHC Portal: https: //unitedhealthcareonline.com• Ohio MITS Portal:

https://www.ohmits.com/prosecure/authtam/login?HOSTNAME=ohmits.com

Helpful Websites


http://www.availity.com/

https://nppes.cms.hhs.gov/NPPES/Welcome.do

http://www.buckeyehealthplan.com/for-providers/providers

https://www.ohmits.com/prosecure/authtam/login?HOSTNAME=ohmits.com


Thank You!

Dottie J. Hauman Revenue Cycle Consultant

Kelly J. SorensenSr. Revenue Cycle Consultant

23240 Chagrin Blvd., Suite 700Cleveland, OH 44122P. 216.831.1200F. 216.831.1842

460 Polaris Parkway, Suite 300Westerville, OH 43082P. 614.794.8710F. 614.794.8712

8800 Tyler Blvd.Mentor, OH 44060P: 440.951.1777

F: 440.951.2143

www.hwco.com877.FOR.HWCO


This educational offering has been reviewed by the National Continuing Education Review Service (NCERS) of the National Association of Long Term Care Administrator Boards (NAB) and approved for 8.75 clock hours and 5.50 participant hours. Program Approval Number: 3072015-8.75-14852-in. For comments please email [email protected].

mailto:[email protected]

Keys to Success in the Billing World Presented by: Dottie J. Hauman, Revenue Cycle Consultant [email protected] Kelly J. Sorensen, Sr. Revenue Cycle Consultant.

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