Knowledgebase

Home Search Tags Glossary

Welcome Guest ( Login | Register )

Latest Additions Most Popular

14.03 PPS Tracking Report

14.03 PPS Tracking Report

Go to Reports > Billing > 14.03 PPS Tracking Report. This report tracks the episode status from beginning to end. There are various filtering options. See details below on how to run the report.

Note: There is also a tab option to search for Missing Episodes. A missing episode can occur when a 485 is printed from POC. The search for missing episodes looks for visits charged to a PPS payer that do not have an episode in PPS tracking. The billing staff member needs to come to this screen at least once a week, before creating billing, and run this report. This screen also has a button that will create all the missing episodes for you. Please see additional article in the Related Links below, for additional information.

How to Run the Report

From Dates = Selects episodes based on the from dates.
Thru Dates = Selects episodes based on the thru dates.
SOC Episodes 1st 30 days
SOC Episodes 2nd 30 days: the other half of the same 485 where the pt was not d/c during the first 30-day episode

485 no OASIS = Shows episodes that have a 485, but no OASIS yet.
OASIS no Visit = Shows episodes that have a 485, OASIS but does not have a first chargeable visit yet.
Visit no RAP = Shows episodes that meet all criteria but the RAP has not been created yet.
RAP no EoE = Shows 1)episodes that have the RAP created but not paid yet or 2) RAP paid but no EoE yet.
EoE sent, not paid = Shows episodes that have an EOE created but has not been paid yet. An additional option will appear to select the Claims created Thru date (default will be 14 days).
EoE paid = The EOE has been paid
On Hold - RAP - Shows RAPS/NOAs that have been put on hold.
On Hold - EOE - Shows EOEs that have been put on hold.
All of the above - Shows all episodes with status' above.

Program(s) / Payer(s) /Team(s) = Filter report by entering program, payer, team number(s). Or leave blank to select all.
Medicare Only = Selects Medicare PPS episodes (Payer has PPS = Yes and Pay Class = B).
Non-Medicare Only = Selects non-Medicare PPS episodes (Payer has PPS = Yes and Pay Class not = B).
Both = Selects both Medicare and non-Medicare episodes.

Print By Options:

Patient’s Name = Orders the report by the patient’s last name.
Episode Status,Patient’s Name= Orders the report by the status above (485 no OASIS, etc) then by the patient’s last name.
Episode Status,From Date= Orders the report by the status then by the episode from date.
Payer, Patient’s Name= Orders the report by the program/payer number and then by the patient’s last name.
Episodes ON HOLD –Except Orders= Will only show episodes that are on hold due to automatic billing errors. This does exclude episodes with just orders outstanding.
Episodes ON HOLD –ALL= Will only show episodes that are on hold due to errors and DOES include outstanding orders.
NOTE: If you want to only view episodes manually put on hold, check the appropriate On-Hold option on the left, and choose one of the top 4 Print By options.
Episodes with KX - Late Reason = Will only show episodes that have been marked with KX and comments for the late reason for RAP/NOA submission.
Double-space the Tracking Report = Leaves a blank line between each episode.
Print the Summary Only = Only prints the last part of the report that shows stats only.
PPS Primary Payer Only = This will only select episodes that have a primary PPS payer entered in the Referral > Payer screen.
Episodes With Errors/Issues Only = Only includes episodes with issues. This will pull up a spreadsheet that shows all errors tied to the episode.

How to Read the Report

HIC# =Medicare/Insurance # from the Referral > Payers screen.
TM = Team number.
Payer = Shows the program number and payer number.
Status = List the status that the episode is currently in.
FromDate/ThruDate = Episode dates.
M0090 Dt = M0090 date on the OASIS for the episode.
RFA = Reason for Assessment on the OASIS for the episode.
HIPPS = HIPPS code that was generated on the RAP claim.
$Amount = The amount associated with the HIPPS code.
Vx = The number of chargeable visits for that episode.
RAP Date / Days = Date the RAP was created and the number of days between the From episode date and the date RAP created.
EOE Date / Days = Date the EOE was created and the number of days between the Thru episode date and the EOE created.

Summary on last page:

SOC Episodes / 2nd 30-day SOC Episodes = The number and HIPPS amount related to the Start of Care episodes.
Recert Episodes / 2nd 30-day Recert Episodes = The number and HIPPS amount related to the Recert episodes.
New Episodes = The number of episodes that do not have an OASIS with a HIPPS code yet.
Billed after = Shows the number of episodes that were billed after the from and thru date of the report.

If certain patients do not appear on the report:

When a 485 is printed from POC, it does not generate an episode in tracking, since POC and billing are not connected. On the 485 screen, when you click on the 485 dates, there's a button at the middle top to Create PPS, which can be used to get the episode into tracking. Also, as part of 14.03, is a tab for Search for Missing Episodes, which looks for visits charged to a PPS payer where there is no corresponding episode.

***Payers that are not PPS do not generate episodes.***

NOTE: The format may display differently based on the options you've selected.

Print Monthly ProRated
When a 30-day episode covers parts of 2 consecutive months, this report will allocate the episode amount into each month. The allocation can be based on either the number of days in each month, or the number of visits in each month. For example, an episode from
Apr 21 - May 20 would have 10 days in Apr and 20 days in May, so allocating based on days would put 1/3 in Apr (10 days of the 30 total) and 2/3 in May. But the episode may have 10 visits between Apr 21 - 30, and then 5 visits May 1 - May 20; allocation based on
visits would be 2/3 in Apr (10 visits of the 15 total) and 1/3 in May. Another option is to use the EOE Dollars. For episodes that have not had the EOE created, the value is one penny. Choosing this option will rate each of those episodes at the HIPPS amount before allocating.

Troubleshooting Tips
485 Missing = There's not a matching 485 episode for the billing cert period
485 Not Mailed = 485 has been created but not yet mailed to the physician
485 no OASIS = There has been a 485 identified but the OASIS is not entered or is not completed yet.Check the OASIS screen to see if the patient has the SOC or Recert OASIS entered and locked.
Select A Different OASIS button:
If the OASIS has been created, but still shows as "485 No OASIS" on the report, try manually selecting the correct OASIS. Go to Billing>PPS Billing>Edit PPS Episodes. Pull up the patient and select the episode. Click Select A Different OASIS button. Select the correct OASIS. Exit and try to bill the RAP/NOA.
OASIS Not Xported = The OASIS has not been exported.
OASIS no Visit = There is not a first chargeable visit in the Locked+Chg status.
Dr Not in PECOS = The physician assigned to the 485 is not enrolled in PECOS. Go to Codes > Other Basic Codes and pull up that physician. Click on Validate using NPPES and then Import information to see if that updates the PECOS. You can also try the following link to verify, here.
Visit no RAP = This means the 485, OASIS and first chargeable visit has been entered appropriately but the RAP has not been created yet.
RAP no EOE = This can be a couple of different things.
o The RAP has been created and sent but not paid yet.  If the RAP claim is aging but has not been paid yet then you will want to check with the payer to see if there were any issues with the claim.
o The RAP was sent and paid but the EOE has not been generated yet.  If the EOE has not been generated yet then the episode will either show up on the EOE billing screen to be sent or it will show up on the EOE error report. The patient must have all documentation returned, the Thru date in the past, and all visits marked as Locked+Chg.
EOE sent, not paid = The EOE has been generated and hopefully sent to the payer. If the claim is aging then check with the payer to see if it is processing or if there were any errors.   See the article attached to view the 999 and 277CA files to see if there were any issues with the claim.
EOE paid = This is when the episode has a zero balance and everything for the episode is finished.
On Hold RAP or EOE = Something is holding the RAP or EOE from being generated.  Usually from outstanding Orders, 485s, Face to Face; and also if you've manually marked the episode as On Hold.  The report will indicate the reason(s) why the claim is being held.