Prior to entering Billing Codes and transferring a remaining balance to an episodic payor (such as Medicare Homecare), users will want to submit the RAP. Refer to Step 1 of the "Transfer amount from commercial/private to episodic" scenario below.
Listed below are instructions for transferring remaining balances in firstHOMECARE, according to the type of payors that are involved in the exchange.
Before performing transfers, users will want to add any codes that need to be submitted on the secondary claim and post the primary payment received:
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Prior to entering Billing Codes and transferring a remaining balance to an episodic payor (such as Medicare Homecare), users will want to submit the RAP. Refer to Step 1 of the "Transfer amount from commercial/private to episodic" scenario below. |
1. Using the main menu to the left, navigate to Patients and select the desired patient using the patient search feature.
2. While inside Intake / Referral division of the Patients area, click the Relationships tab.
3. Navigate to Insurance and then select the Billing Codes tab.
4. Enter any of the appropriate billing codes with values that need to be submitted on the secondary claim.
5. Enter the effective dates and then click 
.
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Each payor may require a different set of codes, please refer to the payors billing companion guide for the appropriate list of codes to be submitted for secondary claims. |
6. Navigate to Accounts | Payments.
7. Verify that the primary payment has been posted to the primary claim and the remaining balance is the accurate amount to transfer to secondary.
8. Proceed to complete the transfer by following one of the appropriate scenarios outlined below.
Listed below are step-by-step instructions for several scenarios related to transferring remaining balances between payors in firstHOMECARE.
Transfer amount from episodic to commercial/private
Example: Primary payor is Triwest (episodic) and secondary is BCBS.
1 Navigate to Accounts | Account Summary. If necessary, select the desired patient that you want to conduct the transfer for.
2 Click the Transfer tab.
3 In the Payor From field, select Triwest (or the episodic payor you are transferring a balance from).
4 In the Payor To field, select BCBS (or the commercial/private payor that you are transferring the balance to).
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When an non-episodic payor is selected in the Payor To field, the Episode field will be disabled. This field is only available if the Payor To is episodic. |
5 The effective date will default to the current date. If necessary, you are able to change this date.
6 Use the Codes section to add group code(s) and reason code(s) for the transfer.
A Click 
(to the right of the Group Codes label), use the Group Code drop-down field below to indicate the appropriate group code for the transfer, and then click .
B After a group code has been saved, you can then click (to the right of the Reason Codes label) to add the appropriate reason code(s) associated with the group code by entering the Reason Code, Amount, and Quantity (if applicable). The Quantity is only necessary when multiple reason codes exist for one group code entry.
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Each group code entry can have up to six reason codes associated with it. Users can delete group or reason codes by selecting the code entry from the corresponding grid and clicking |
7 To capture batch details for a specific month, users can utilize the Items with Statement Dates In / Through fields by entering a date range and then clicking 
.
8 In the column on the far left, check the corresponding box next to the dollar amount you want to transfer that is listed in the Amount To Transfer column. This dollar amount may need to be changed in order to reflect the month or week you are transferring.
A To calculate the correct Amount To Transfer for each month (adjust for weekly):
a Total remaining balance / Total number of visits in each episode = Dollar amount per day
b Dollar amount per day x Number of visits in that month = Amount To Transfer
9 In the Batch Details section, uncheck the box next to any visits that you do not wish to transfer to the secondary payor.
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The prior Payment fields will not be editable. This is necessary since episodic payors are not reimbursed per visit but rather the episode in its entirety. The software takes the prior payment amount posted and divides it equally among the total number of visits in order to calculate a dollar amount per visit. |
10 Click 
to initiate the transfer.
11 Navigate to Accounts | Billing | Create Batch.
A Using the Payor drop-down field, select BCBS.
B Check the Transfers box and then click Create Batch.
C Click Save Batch.
D Click the Work With Batches tab, select the corresponding claim in the grid, and then click Commit Clean Claims.
E Click the Post Batches tab, select the corresponding claim in the grid, and then click Submit Bill.
F Process the claim following your agency's normal billing process.
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When transferring from an episodic insurance provider to a non-episodic, commercial/private provider, the secondary insurance may need to be billed per week or per month. Users must transfer the visits in a separate transfer transaction for each week or month. Example: Episode spans 7/15/2017–9/12/2017, BCBS was secondary for July–September and needs to be billed per month in sequential order. Users would navigate to the Transfer screen, adjust the Amount To Transfer to only reflect the month of July (only checking batch detail items for July), click |
Example: Primary payor is BCBS and secondary payor is Medicare Homecare
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A RAP is required to be submitted to Medicare for a secondary claim. Prior to entering Billing Codes or transferring the remaining balance, users will want to submit the RAP to Medicare following your normal billing process. If the RAP has not been submitted prior to billing the transferred Final claim, users will receive a Fatal billing warning “No RAP - No posted RAP found for this final claim”. |
1 Navigate to Accounts | Billing | Create Batch.
A Using the Payor drop-down field, select Medicare Homecare.
B Check the Process RAP box and then click Create Batch.
C Click Save Batch.
D Click the Work With Batches tab, select the corresponding claim in the grid, and then click Commit Clean Claims.
E Click the Post Batches tab, select the corresponding claim in the grid, and then click Submit Bill.
F Process the claim following your agency's normal billing process.
2 Navigate to Patients | Intake / Referral | Insurance | Billing Codes to enter any codes that should be submitted with the Final/EOE secondary claim.
3 Navigate to Accounts | Account Summary. If necessary, select the desired patient that you want to conduct the transfer for.
4 In the Payor From field, select BCBS (or the commercial/private payor you are transferring a balance from).
5 In the Payor To field, select Medicare Homecare (or the episodic payor that you are transferring the balance to).
6 The effective date will default to the current date. If necessary, you can change this date.
7 Use the Episode drop-down menu to select the desired episode to apply the remaining balance to.
8 Use the Codes section to add group code(s) and reason code(s) for the transfer.
A Click (to the right of the Group Codes label), use the Group Code drop-down field below to indicate the appropriate group code for the transfer, and then click .
B After a group code has been saved, you can then click (to the right of the Reason Codes label) to add the appropriate reason code(s) associated with the group code by entering the Reason Code, Amount, and Quantity (if applicable). The Quantity is only necessary when multiple reason codes exist for one group code entry.
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Each group code entry can have up to six reason codes associated with it. Users can delete group or reason codes by selecting the code entry from the corresponding grid and clicking |
9 To capture batch details for a specific month, users can utilize the Items with Statement Dates In / Through fields by entering a date range and then clicking .
10 In the column on the far left, check the corresponding box next to the dollar amount you want to transfer that is listed in the Amount To Transfer column. If necessary, correct the dollar amount.
11 In the Batch Details section, enter a dollar amount in the Prior Payment column for each corresponding visit line that you are transferring to secondary. Uncheck the box next to any visits that you do not wish to transfer to the secondary payor.
12 Click to initiate the transfer.
13 Navigate to Accounts | Billing | Create Batch.
A Using the Payor drop-down field, select Medicare Homecare.
B Check the Transfers box and then click Create Batch.
C Click Save Batch.
D Click the Work With Batches tab, select the corresponding claim in the grid, and then click Commit Clean Claims.
E Click the Post Batches tab, select the corresponding claim in the grid, and then click Submit Bill.
F Process the claim following your agency's normal billing process.
Example: Primary payor is BCBS and secondary is Aetna.
1 Navigate to Accounts | Account Summary. If necessary, select the desired patient that you want to conduct the transfer for.
2 Click the Transfer tab.
3 In the Payor From field, select BCBS (or the commercial/private payor you are transferring a balance from).
4 In the Payor To field, select Aetna (or the commercial/private payor that you are transferring the balance to).
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When an non-episodic payor is selected in the Payor To field, the Episode field will be disabled. This field is only available if the Payor To is episodic. |
5 The effective date will default to the current date. If necessary, you are able to change this date.
6 Use the Codes section to add group code(s) and reason code(s) for the transfer.
A Click (to the right of the Group Codes label), use the Group Code drop-down field below to indicate the appropriate group code for the transfer, and then click .
B After a group code has been saved, you can then click (to the right of the Reason Codes label) to add the appropriate reason code(s) associated with the group code by entering the Reason Code, Amount, and Quantity (if applicable). The Quantity is only necessary when multiple reason codes exist for one group code entry.
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Each group code entry can have up to six reason codes associated with it. Users can delete group or reason codes by selecting the code entry from the corresponding grid and clicking |
7 To capture batch details for a specific month, users can utilize the Items with Statement Dates In / Through fields by entering a date range and then clicking .
8 In the column on the far left, check the corresponding box next to the dollar amount you want to transfer that is listed in the Amount To Transfer column. If necessary, correct the dollar amount.
9 In the Batch Details section, enter a dollar amount in the Prior Payment column for each corresponding visit line you are transferring to secondary. Uncheck the box next to any visits that you do not want to transfer to secondary.
10 Click to initiate the transfer.
11 Navigate to Accounts | Billing | Create Batch.
A Using the Payor drop-down field, select Aetna.
B Check the Transfers box and then click Create Batch.
C Click Save Batch.
D Click the Work With Batches tab, select the corresponding claim in the grid, and then click Commit Clean Claims.
E Click the Post Batches tab, select the corresponding claim in the grid, and then click Submit Bill.
F Process the claim following your agency's normal billing process.
Example: Primary payor is BCBS and secondary is Self-Pay.
1 Navigate to Accounts | Account Summary. If necessary, select the desired patient that you want to conduct the transfer for.
2 Click the Transfer tab.
3 In the Payor From field, select BCBS (or the commercial/private payor you are transferring a balance from).
4 In the Payor To field, select Self-Pay (or the Medicaid payor/Self-Pay that you are transferring the balance to).
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When an non-episodic payor is selected in the Payor To field, the Episode field will be disabled. This field is only available if the Payor To is episodic. |
5 The effective date will default to the current date. If necessary, you are able to change this date.
6 Use the Codes section to add group code(s) and reason code(s) for the transfer.
A Click (to the right of the Group Codes label), use the Group Code drop-down field below to indicate the appropriate group code for the transfer, and then click .
B After a group code has been saved, you can then click (to the right of the Reason Codes label) to add the appropriate reason code(s) associated with the group code by entering the Reason Code, Amount, and Quantity (if applicable). The Quantity is only necessary when multiple reason codes exist for one group code entry.
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Each group code entry can have up to six reason codes associated with it. Users can delete group or reason codes by selecting the code entry from the corresponding grid and clicking |
7 To capture batch details for a specific month, users can utilize the Items with Statement Dates In / Through fields by entering a date range and then clicking .
8 In the column on the far left, check the corresponding box next to the dollar amount you want to transfer that is listed in the Amount To Transfer column. If necessary, correct the dollar amount.
9 In the Batch Details section, enter a dollar amount in the Prior Payment column for each corresponding visit line you are transferring to secondary. Uncheck the box next to any visits that you do not want to transfer to secondary.
10 Click to initiate the transfer.
11 Navigate to Accounts | Billing | Create Batch.
A Using the Payor drop-down field, select Self-Pay.
B Check the Transfers box and then click Create Batch.
C Click Save Batch.
D Click the Work With Batches tab, select the corresponding claim in the grid, and then click Commit Clean Claims.
E Click the Post Batches tab, select the corresponding claim in the grid, and then click Submit Bill.
F Process the claim following your agency's normal billing process.
. If a group code is deleted, all reason codes associated with it will also be deleted.