During the pre-billing chart audit, verify the following:

a.  The 485, and the F2F (if applicable), for the billing period, has been returned and signed by the Physician.

b.  All pertinent verbal orders have been returned and signed by the Physician.

c.  All visits have been entered and keyed using the correct job codes.

d.  All supplies have been entered and assigned HCPCS codes.

e.  All charges are under the correct payer source, especially if the patient has more than one payer source listed.

f.  The visits/frequency/supplies match what’s on the POC (or verify by using any supplemental orders).

g.  Within the referral, especially with new admits, make sure you have the physician NPI Number and taxonomy code.

h.  If the patient has Carolina Access, make sure the Carolina Access number has been entered in the referral.  KB article:  Carolina Access Number 

i.  If the patient’s Carolina Access Provider is different from the patient’s primary physician,  follow steps to Cross-Reference NPI. KB article:  Cross-Reference NC Access # to NPI

Medicaid Billing: If the patient is Medicaid primary, but patient also has Medicare, verify that the proper condition codes are listed in the referral.  KB article:  Condition Codes

Medicare Billing:  If the patient was transferred from another HHA, directly prior to your admission, verify the appropriate condition code (47) is listed under Referral > Payers > Extra Billing Info.  It is important that the Intake Dept provides this information to the billing staff.  Depending on your agency roles, the Intake Dept or the Billing Staff will need to manually enter this code.  If this code is required, but not provided on the NOA, the claim will deny and this may cause payment penalties, due to late submission of the NOA.

A.  When billing EOE, make sure the correct from and thru dates are on the claim.  If patient was discharged before the end of episode, verify that the patient has been correctly discharged from the Barnestorm system.  Other wise, the claim dates will show the full episode period, instead of the start and d/c date.  

Discharging the Patient:  It is always important to mark the patient as discharged, when the patient has been discharged, in a timely manner.  Specifically for Medicare billing, this is very important.  If the patient is not marked as discharged, episodes will continue to generate for the patient, causing NOAs to appear for billing and additional episodes to create.