EOE:  My Claim Has Denied, How Do I Remove (Cancel) the Episode from Tracking?

These instructions are for when visits were provided during an episode; however, the payer has denied the claim due to billing requirement(s) not met, such as no F2F; no authorization obtained; denied due to ADR; or timely filing has expired.  You can also run the same steps if you have determined an episode is no longer billable and payment is not expected.

This is a 2-step process to remove the episode from showing up on billing/AR reports.

Step 1:  Remove from PPS Tracking

• Go to Billing > PPS Billing > Edit PPS Episodes.
• Select the patient/chart # in the Search field and then select the episode.
• Under “Reason(s) For Not Receiving Full Payment,” select Denied.

• You will receive this popup:

• Select Yes, if you wish to proceed.  (Select No if you want to cancel.)
• If you select Yes, a second popup will appear indicating the # of visits that will be changed to $0.  Make sure you want to make these changes before selecting Yes.  Select Yes if you wish to continue.  Select NO to stop.

• A separate section will then appear for you to select the appropriate nonbillable visit status code to assign to the visits, such as: uncollectable, unbillable due to no auth etc.  Select the code you want to use.  (If you do not see an appropriate code already created for your agency, go to Codes > Visit Status Codes to create a more specific code to match your needs.)  If you wish to discontinue, click Cancel.

• Once you’ve selected the code, select the “Make the episode visits no charge” box.  This will change all the visit status’ to the code you’ve selected and mark those visits as $0 charge.
• You will then receive a popup indicating the number of visits changed.  Press OK.  This will mark the episode as “paid” at $0, but with a DENIED status, time-stamped with current day’s date; and will be marked as Cancelled.  The episode is now removed from tracking and will no longer show up for billing. 

NOTE:  EOE DATE PAID = This is when the episode has a zero balance, and no further payment is expected.

Next, you will resolve the account in AR.

Step 2:  Remove balance from AR

Normally when payment is not expected, the agency has a procedure to write-off those balances to remove them from Accounts Receivable.

• Go to Accounts Receivable > Post Payments > Post Paper Remittances.
• Enter chart number for the patient, or key in first 3 letters of last name and select the patient.
• (If the patient has been discharged, choose the proper bullet that indicates number of days discharged.)
• The patient’s A/R history will appear on the screen.  Click on the line that holds the balance to be written off.
• A mini screen will appear (see below) – “Add/Edit An Accounts Receivable Posting Entry” – Verify Transaction  Date.
• At Amount # 1, you will enter the amount to be written off.
• At Code # 1, you will enter the pay/adj code that indicates a write-off.
• There is a Comments section where you can enter a brief note.
• Select Save.
• On the right of screen is a list of tabs; select View Detail (To verify your posting is correct.).
• Then continue downward and select Print.
• Select View Totals (To verify total is correct).
• Select Approve Totals.
• Select Post Entries (A box will appear "Posting is complete.").
• Select Refresh A/R Detail to view your changes.

To Get a Total$ of Your Write-offs, Here Are a Few Report Options:

05.07 Pay/Adj Code Totals by Quarter - This report does not include the option to filter by pay/adj code.

05.08 Selected Detail - This report does include the option to filter by pay/adj code.  If you are just printing details of write-offs, enter your agency code(s) for write-off in the pay/adj code field.

05.11 Totals By Program/Pay/Adj Code - This report includes the option to filter by pay/adj code.  If you are just printing details of write-offs, enter your agency code(s) for write-off in the pay/adj field.

To Locate Your Payment/Adjustment Codes

• Go to Accounts Receivable > Pay/Adj Codes
• The codes will be listed on bottom, right of the screen.  Select the program number to view the pay/adj codes your agency has set up.  Use the Print buttons to view the reports.
• If you need to set up a new pay/adj code, click here for the article link.