Hospice Billing Readiness Checklist

The following instructions are a blend of best practices and mandatory tasks designed to make your agency’s billing process smoother and timelier. Click on the links for detailed instructions of how to perform the task.

Pre-Billing Best Practices

Although the following items are optional, it is considered Best Practice to make sure these items are complete prior to pulling a batch. Items in this section should be reviewed for each patient.

To verify that an IPOC has been signed by the Physician:

1. From the Main Menu, click Document Tracking, select Orders/IPOC/F2F.

2. Select IPOC/Phy Orders from the drop-down menu for Document Type.

3. Select No from the drop-down menu for Signed By Physician.

4. Click Search in the bottom right corner of the search criteria. Results are displayed directly below the search criteria. If no results are displayed, all IPOCs are signed.

To verify that a F2F document has been signed by the Physician:

● From the Main Menu, click Document Tracking, select Orders/F2F.

● Select Face to Face Only from the Document Type drop-down menu.

● Select a Patient Name from the drop-down menu.

● Select No from the drop-down menu for Signed by Physician.

● Click Search in the bottom right corner of the search criteria. Results are displayed directly below the search criteria. If no results are displayed, all F2F documents are signed.

● Orders (exclude order types that are IDT Frequencies) are signed by Physician before billing the EOE

To verify that an Order has been signed by the Physician:

1. From the Main Menu, click Document Tracking, select Orders/F2F.

2. Select Orders Only from the Document Type drop-down menu.

3. Select a Patient Name from the drop-down menu.

4. Select No from the drop-down menu for Include Initial/Recert Orders.

5. Select No from the drop-down menu for Include Assess/Eval Orders.

6. Select No from the drop-down menu for Signed by Physician.

7. Click Search in the bottom right corner of the search criteria. Results are displayed directly below the search criteria. If no results are displayed, all orders are signed.

Pre-Billing Mandatory Tasks

The following items must be reviewed prior to billing. There are not currently any billing errors related to the first two items that would appear when reviewing the batch, so it's imperative to complete all items listed below.

To verify that Visits have been Logged:

1. From the Main Menu, click Tools then select Schedule Review.

2. Select a Patient Name from the drop-down menu.

3. Click the boxes next to Unassigned, Assigned, Pending, and Completed in the Status field to select them.

4. Click Filter. Any items displayed at the bottom of the screen still need to be released. The goal is for no results to be displayed as this indicates that all scheduled visits have been released. Additional information on Releasing visits can be found in the Schedule Release process section.

The next steps (5-9) are optional and are if you prefer to verify this list against the calendar.

1. From the Main Menu, click Reports, select Patient from the Report Category drop-down menu.

2. Select Encounter from the Report Name drop-down menu.

3. Select the desired patient from the Patient Name From and Patient Name Through drop-down menus.

4. Select the desired Service From and Service Through dates.

5. Click Preview. This report displays the visits that will pull to the claim, with the exception of any visits marked as non-billable. Any visits marked non-billable will not pull to the claim.

Check HIQA to make sure that the NOE has successfully posted to the Common Working File (CWF). You will need to contact the EDI Help Desk for any DDE related questions.

Due to the new CMS hospice regulations, it is important to make sure you enter all medication fills and refills into Tools | Medication Fills. Additional information is included in the Medication Fills section.

The agency biller should ALWAYS complete this task, regardless of whether or not other agency employees have reviewed the information listed in Best Practices.

To review batch warnings and errors:

Before completing these steps you must first create your batch. Additional information on creating a batch is included in the Billing Creating a Batch section.

1. From the Main Menu, click Accounts, select Billing and Work with Batches.

2. Click on the desired batch in the listing. A Claim Summary is now visible directly below the Select a Batch listing. The summary is split into two sections:

● Clean/Warning - Claims appearing in this list may be billed, although some may have issues that need to be reviewed. Claims without issues are labeled as Clean. Claims with issues are labeled as Warning.

● Fatal - Claims in this list have issues that must be resolved prior to billing.

3. Click the Expand/Hide All Warnings and Expand/Hide All Errors links if details on each item are not already visible. Each warning/error should appear in a bulleted list below the claim.

4. Click directly on the desired warning/error to go directly to that location in Enterprise Edition to make the necessary corrections. *Remember all billing warnings and errors are setup for each individual Payor/Plan within the Payor/Plan Master File. See the Master Files - Payors and Plans cheat sheet from the Database Readiness packet for more information on the setup.

Pre-Billing Process Recommendations

This section includes some specific things a clinical super user should be looking for periodically to help avoid issues during the billing process.

To check for Orders, F2F, and IPOCs that are sent but not signed:

1. From the Main Menu, click Reports.

2. Select Admission from the Report Category drop-down menu.

3. Select Late Orders/F2F/485s from the Report Name drop-down menu. This displays a list of report filter criteria. Set report filter criteria as appropriate.

4. Click Preview. This report displays orders, F2F, and 485s that have been sent, but not signed.

To check for Visits that haven't been completed:

1. From the Main Menu, click Tools, select Schedule Review.

2. Enter the desired date range. This should be entered according to how frequently you will be reviewing the report (weekly, bi-weekly, and so on).

3. Check the boxes for Unassigned and Assigned in the Status field.

4. Click Filter. Results are displayed at the bottom of the screen, displaying visits that have not been completed.

To check for P Pages that haven't been completed:

1. From the Main Menu, click Document Tracking, select Documents.

2. Select the box next to Documents without P Page Saved to select it.

3. Click Search in the bottom right corner of the search criteria. Results are displayed directly below the search criteria. This search displays documents that have been created, but do not have a completed P Page. *Note that there are some documents, such as OASIS transfer, for which staff may not fill out the P Page.

To verify that all documents with P Pages have been Completed and Locked:

1. From the Main Menu, click Tools, select Charge Verification.

2. All visits entered on P Pages that fall within the designated time frame (one month by default) will be displayed.

3. Review all charges for accuracy. Corrections can be made by highlighting the appropriate visit in the listing and then clicking the Clinical Document tab at the top of the screen.

4. Click Approve All in the top left corner once all items have been verified (and corrected where necessary).

5. Click Save.

To verify that all documents with a P Page have been Completed and Locked:

1. From the Main Menu, click Tools, select Schedule Review.

2. Select an item from the Discipline drop-down menu. The discipline you select should have Scheduling Release Process set as the Visit Behavior, which denotes that the agency does not complete P Pages for this discipline.

3. Click the box next to Completed in the Status field to check it.

4. Select filter options to narrow the search, and then click Filter to display the list at the bottom of the window. You may wish to choose a specific patient or employee along with a date range if working off a timesheet.

5. Review all visits in the list for accuracy.

6. Perform the Schedule Release process.

You must approve charges that originate from clinical document P pages before billing in the Charge Verification tool.

1. From the Main Menu, click Tools, and then select Charge Verification. Enterprise Edition displays all charges requiring approval that meet the filter criteria.

2. Select the check boxes under Approve next to the applicable charges, or click Approve All.

3. Click . Charge verifications are now in Charge Entry and are available for billing.

Service charges that the system automatically populates to charge entry (whether from schedule release or P-page verification), are auto-assigned to the primary payer listed on the patient record. If there are any charges that you need to bill under a plan attached to the patient beyond the primary payer, you must edit them in Charge Entry and select the correct payer sequence:

1. From the Main Menu, click Accounts, and then select Charge Entry.

2. In the list of visit records, select a visit to edit services.

3. Under Service, click the arrow beside the Payor field and select the correct payer sequence.

4. Click . The system displays the primary and secondary plans for the visits in the list of visit records.