December 18, 2007
Editor: Jeff Johnston
As I’m sure you are all well aware, the infusion industry has had an ongoing challenge in meeting Medicare billing requirements when needing to bill only for a denial. The challenging part has been the requirement to bill Medicare according to their guidelines, and then, bill the commercial payor according to that payor’s guidelines (J codes, S codes, etc.).
In CPR+ v8.0 we introduced a new feature that enables you to meet this dual-guideline billing challenge.
Two Unique Sets of Line Items
With this new feature, you can create two sets of line items when creating a Medicare for Denial claim. This functionality allows the user to set up the claim to bill Medicare with the correct number of line items and the correct codes, and also to define the way that the secondary payor will be billed. You can easily create a four or five line item primary claim to Medicare and a two line item claim to your secondary payor, collapsing line items and editing descriptions or codes as needed. One caveat is that you must keep the total dollar amount of the Medicare claim and the secondary claim the same, however, CPR+ will not allow you to save the second set of line items until the dollar amounts match.
Because the user creates both sets of line items at the time of creating the initial claim, CPR+ will use the line items associated with the secondary payor when the balance is transferred from Medicare. No additional editing is necessary. This new feature gives the user the flexibility of having a cash poster transfer the balance from Medicare to the commercial payor at the point of cash entry.
Here’s How It Works
As with any situation where Medicare is primary, but the billing is being done only for the purpose of receiving a denial, the Delivery Ticket will be assigned to the payor that will actually be paying the claim. This ensures that the billable items and expected amounts are set correctly for the payor that will pay the claim.
Select the Delivery Ticket and “Create Invoice (F9)”. Select Medicare as the payor and when the claim header screen is displayed, check the checkbox in the upper right-hand side of the screen labeled “Bill for Denial”. This tells CPR+ that you want to create another invoice for denial.
When your biller goes to the “Line Items (F4)” screen they will copy charges from the Delivery Ticket as if they were creating the claim for the SECONDARY payor. Notice a new button on this screen labeled “Denial Lines (F12)”. Click this button to create the line items for the Medicare claim.
When your biller goes to the “Denial Line Items” screen, they are free to manipulate the charges in any way necessary to bill Medicare according to policy. He or she can create derived billing kits from the Delivery Ticket items, pull new charges from inventory, add modifiers, change codes and descriptions; essentially, complete freedom is granted as long as the billed amount and the expected amount match (to the penny). The Billed and Expected Amounts from the “real” claim (the one for payment, to the secondary payor) are displayed at the bottom of the “Denial Line Item” screen. Once the “Denial Line Items” are created to the satisfaction of your biller, they need simply to close the screen and continue the billing process as normal. This claim will go to the Medicare electronic claims queue with the “Denial Line Items” and transmit as such.
At the time the denial is received from Medicare, and the entire claim balance is transferred to the secondary payor, the user will see the “real” line items that were created first in the process, not the “Denial Line Items”. At this point, the cash poster can add the COB information and transmit the claim to the Secondary Payor. It’s as simple as that! If you have questions about this or any other CPR+ functionality, be sure to check out the free On-Demand training videos or give us a call to arrange one-on-one training.
D.H.S. will, of course, have a Level II Customer Support Representative available to assist you with any issues that may arise over the upcoming Christmas Holiday. As a reminder, D.H.S. offices will close early on Christmas Eve at 5 PM EST (Dec. 24th) and will be closed Christmas Day (Dec. 25th).
From all us to all of you – we wish you all a very happy, healthy and prosperous Holiday.
By Stuart Crane
Have you ever worked with a list (grid) in CPR+ and wondered HOW MANY unique entries of a particular item there were in that list? For example, if you pull up your inventory (Main Menu option #6. Inventory, #2. Add / Modify, F6 - Pick Supplies), you see a list of all of your supply items -- how many are from a particular Manufacturer or Supplier?
In v8.0, you can quickly and easily find out simply by RIGHT-CLICKING on the column header ("Manufacturer") and then clicking "Count". This will display a new list/grid that shows EACH UNIQUE MANUFACTURER, the total (count) of how many entries for that manufacturer, and the percentage it makes up of the total, sorted in descending order by total. This works on most, but not all, grids in CPR+ v8.0. Want to know how many Ready-To-Bill Tickets are waiting to be billed for each unique payor? Simple, just right-click "Payor" in the RTB file and click “Count”!
We are pleased to announce Plus Points!, a new program to reward CPR+ customers who give us feedback and help us develop, test or promote CPR+.
As most of you are aware, we are constantly looking for input, feedback and suggestions for how to make the program better. In addition, we are frequently asked to provide customer references and/or arrange site visits with existing CPR+ customers for companies who are evaluating CPR+. In all likelihood, your organization visited or at least spoke to one or more existing customers before purchasing CPR+. Over the years, many of you have been gracious enough to speak to prospective CPR+ customers or to host a site visit with an interested company. Others have been a beta site for an optional module or a new release and you’ve given us feedback and suggestions to make the system work better. We know that all these things take time and effort, and we are extremely grateful. To show our appreciation, we are instituing the Plus Points!
With the CPR+ Plus Points! program, you can accrue points each time you give us feedback or help us develop, test or promote the system, and unlike your frequent flyer miles, your Plus Points! will never expire and no Saturday night stay is required. You can cash-in your Plus Points! whenever you’d like toward training services. To view a list of activities that will earn Plus Points!, click here. Thank you for being our customer. If there is anything we can do you improve your experience with D.H.S. or CPR+, do not hesitate to let us know.
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