| Referral > Demographics | Make sure patient Gender is marked
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| Referral > Demographics | Patient date of birth should NOT be 1/1/1900 |
| Referral > Dr + Pharmacy | Make sure Primary Physician is noted and has a valid NPI number
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| Referral > Start | Make sure the County is indicated (CBSA denial is always county)
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Referral > Payers
| Make sure the HIC# is valid for the payer
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Codes > Other Basic Codes > Doctors
| Check the NPI for the doctor, and the CA as needed.
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Correct the Doctor NPI
| This article tells how:
http://kb.barnestorm.us/KnowledgebaseArticle50694.aspx |
Cross Reference NPI to CA
| This article tells how:
http://kb.barnestorm.us/KnowledgebaseArticle50172.aspx |
Codes > Rates >
Job Codes
| Check the job code used on the visits for the correct HCPCS code
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Billing > PPS Billing >
Edit PPS Episodes
| Check all of the information on your RAP:
- Has it been cancelled or put on hold?
- Is the from date correct?
- Is the admission date correct?
- Does the HIPPS code match?
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| | To correct a HIPPS code, you follow the instructions in our KB article, OASIS Correction, for correcting a KEY FIELD. http://kb.barnestorm.us/KnowledgebaseArticle50435.aspx
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OASIS Correction
| The from and thru dates and admission date on the initial RAP are the same. Therefore, the 0023 line item service date must also match. http://kb.barnestorm.us/KnowledgebaseArticle50435.aspx
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| | Check the from and thru dates and total cert period days.
http://kb.barnestorm.us/KnowledgebaseArticle50435.aspx
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| | Therapy need--correct as needed and resubmit.
http://kb.barnestorm.us/KnowledgebaseArticle50435.aspx
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Referral > Payers >
Extra Billing Info
| If the error code indicates that you need a condition code, include the appropriate condition code and make sure that there are no other codes listed for that claim set date.
D0 - changes to service dates
D1 - changes in charges
D2 - changes in revenue code/HCPC
D3 - second or subsequent interim PPS bill
D4 - change in grouper input (DRG)
D5 - cancel only to correct a hic or provider number
D6 - cancel only - duplicate payment, outpatient to inpatient overlap, OIG overpayment
D7 - change to make Medicare secondary payer
D8 - change to make Medicare primary payer
D9 - any other changes.
EO- change in patient status note: if you are having trouble getting
E0 change in patient status. Note: if you are having trouble getting E0 to process and it is correctly applied to the claim please contact call center.
If D9 code is missing:
- Look up the patient in Referral and go to Payers > Extra Billing Info.
- Remove any old billing dates and any other condition codes, such as D7.
- Add a new date set to cover the current claims and make sure D9 is the only condition code listed.
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