Adding a Plan

o     If the plan is Medicare or Medicaid, select this check box.

o     If the plan pays episodically, select this check box. When you select the Episodic check box, the system displays the following options:

§      Select the PPS 2008 check box for PPS 2008 billing rules.

□     When you select this check box, the system displays the Quality of Data Penalty check box. Select this check box if you want to apply the CMS 2% payment penalty for the Quality of Data Reporting Requirements.

§      Select the Apply CMS Episodic Therapy Tracking Requirements if this is required for your agency.

 

If the payor requires tracking for visit reassessments or similar items (such as the CMS therapy reassessment requirements), when this box is selected, Enterprise Edition will track this payor to meet therapy requirements. When this box is selected you will be able to run Therapy Reassessment reports to ensure that your agency is meeting the requirements.

If the plan is not episodic and you normally obtain authorizations, select the Schedule From Auth check box to allow your agency to enter authorizations from the Authorization tab and then schedule from those authorizations.

The Schedule From Auth option should be used by agencies that will only perform services for the number of authorizations that have been approved by locking down Scheduling from Authorizations. This option allows you to create visits in Scheduling from the Authorizations tab. This function works for all types of Authorization frequencies except for Flat. (Flat frequencies are not included in this option because the definition is a "flat" set of visits for a discipline which does not have any scheduling logic for the number of visits per week or days that are best for visits.) Text orders can still be entered for tracking any necessary orders from physicians, however, visit frequencies would be driven from the Authorization.

When this option is selected you will not see the Schedule shading from Authorizations because the authorization defines the calendar, but can generate visits in the Schedule.

Refer to Authorization Schedule Settings for more information on how this setting functions with authorization information entered in Patients | Intake / Referral | Insurance.

 

Select this check box if your agency requires an open authorization in order to create documentation. (This option is not available if you selected the Schedule From Auth check box).

Refer to Authorization Schedule Settings for more information on how this setting functions with authorization information entered in Patients | Intake / Referral | Insurance.

 

Check this box if you need the HIPPS Units to be set to "0". The check box will only be visible if the selected plan's payment source is not Medicare A and is by default not checked. The checkbox will only be enabled if either the Episodic or Include HIPPS information for Non-Episodic MA plans checkbox is checked. When claims are generated and the checkbox is not checked, the UB04 0023 line item Unit Quantity will be set to "1". When claims are generated and the checkbox is checked, the UB04 0023 line item Unit Quantity will be set to "0". Existing batches on the Work With Batches tab will need to be refreshed to see the above noted changes.

If the plan is Non-Episodic and is a Medicare A plan and you need to see the HIPPS information in billing, check this box.

For Medicare payors/plans included in the pre-claim review model, check this box to indicate the first episodes that the UTN billing functionality will apply to (i.e. UTN billing warning, UTN on UB04 and 837):

●     By default, this date field will be blank.

●     This field will only display for a payor/plan that has a Payment Source of Medicare (in Payors).

●     The software uses this date to determine when the "Missing UTN" billing warning is enabled and when UTN numbers will be included in the 837 files and UB04 forms for final claims.

●     The "Missing UTN" billing warning is only triggered for applicable episodes that begin on or after this date.