After you verify or release charges you can create a billing batch. Use the Create Batch tab to create a batch of claims for each office, based on the criteria you enter on the tab.
1.From the Main Menu, select Accounts, then select Billing, and click the Create Batch tab. Enterprise Edition uses the information you select under Criteria to determine what goes into the billing batch you are creating.
●Office— You may create a billing batch for one office at a time. Enterprise Edition uses the office you select to collect charges for patients with admissions in that office. Click the arrow beside this field and select the office for which you want to create a batch.
●Payor— Click the arrow beside this field and select one or more payor(s) for the office you selected. You may create batches for all payors under a financial class, individual payors, or multiple financial classes.
●Sequence— Enterprise Edition uses the sequence to look for patients with the specified payor(s) listed in the Billing Seq field (on thePatient Insurancetab) in that particular sequence (1=primary, 2=secondary or 3=tertiary). Click the arrow beside this field and selectPrimary,Secondary, orTertiary.
●Bill Thru Date— Enter the latest date (in themm/dd/yyyy format) you want to use for gathering the claims you want to batch, or click and select a date from the calendar. HEALTHCAREfirst recommends you use the current date for Home Health billing and the last date of the month being billed for Hospice claims.
Selecting the Process RAP check box for episodic type payors ensures that the system examines only episodic plans for the selected payor on the patient records to put into the batch you are creating. For example, if a private insurance company has multiple plan types (one episodic and one non-episodic), selecting the Process RAP check box would ensure that only the episodic plan is billed for the specified payor in the batch. Once you select the Process RAP check box, the system looks for the following criteria and presents patients that qualify under each:
Any patient with an episode and a billable visit entered for the episode. When a patient is in this state, the RAP is ready to send.
Any patient with an episode but no billable visit entered. This helps the agency keep track of episodes established but missing a billable visit to proceed with billing.
Selecting the Process RAP Final check box for episodic type payors ensures that the system examines only episodic plans for the selected payor on the patient records to put into the batch you are creating. Once you select the Process Final check box, the system looks for the following criteria and presents patients that qualify under each:
Any patient without a discharge date with an episode end date prior to the current date for which you are creating a batch. For example: A patient episode is 04/01/2010 through 05/30/2010. The bill thru date is 06/02/2010. Enterprise Edition would pull the patient episode to the final claim batch because the episode period ended and is final claim ready.
Any patient with a discharge date equal to or prior to the bill thru date when you are creating the batch. For example: A patient episode is 04/01/2010 through 05/30/2010. Your agency discharges the patient on 05/15/2010. The bill thru date is 05/17/2010. The system would pull the patient episode to the final claim batch because the patient was discharged prior to the entered batch date.
You may select the Process RAP and Process Final check boxes at the same time to create a single batch of patient charges containing both RAPS and Final Claims meeting any of the criteria described above. Medicare, however, does not allow you to submit the RAP and the Final Claim for the same episode in the same billing batch file. Therefore, the system does not allow a patient’s RAP and Final Claim for the same episode to pull into a batch together. It will allow a mix of RAPS/Finals for different episodes to combine in the same batch.
●Process Non-episodic— To bill non-episodic payors, select theProcess RAPorProcess Non-episodiccheck box. Enterprise Edition gathers records for patients with only non-episodic plans for the selected payor for the batch.
2.Click Create Batch. Enterprise Edition displays a processing box while gathering patient claims matching the criteria. When finished, the system displays the following:
To coincide with a CMS mandate for Hospice Medicare payors, the software will automatically split claims that contain vaccine revenue codes. If any 771 or 636 revenue codes are detected while charges are being reviewed, the software will place all corresponding 771 and/or 636 revenue codes into a separate claim. All other revenue codes (i.e. 651, 652, 656, etc.) will remain in the initial claim. This will also create two separate entries in the Accounts Receivable grid (in Accounts | Account Summary).
For this to function properly, agencies must setup the revenue code reference files for administration of the vaccine (using revenue code 771) and for each vaccine your agency administers (using revenue code 636).
●A list of patient claims that are grouped in two different sections (according to the type of billing errors):
§Clean/Warning— You may post claims with this status, with the warning, when you post the batch.
§Fatal— You may not post claims with a "Fatal" status until fixed.
●A summary above the list of claims noting how many claims have the Clean/Warning status and how many have the Fatal status.
●The Estimated Total of all claims in each area
3.If necessary, you may exclude patient claims from the batch (prior to saving the batch), which allows you to pull the patient claim to another batch at a later time. Check the box in the Exclude column for any claims that you do notwant to be included in the batch.
4.Click Save Batch. Enterprise Edition will then promote the batch to the Work With Batches screen.
Enterprise Edition does not post patient A/R when you exclude a claim from the batch.
After creating a batch, you are then able to proceed with the billing process in Work With Batches.
and select a date from the calendar. HEALTHCAREfirst recommends you use the current date for Home Health billing and the last date of the month being billed for Hospice claims.