The key to successful billing is getting claims out“ timely” and “clean.”  Below is a list of the basic steps to getting those claims out “timely”, “clean” and to ensure there is a steady flow of income for your agency.  (It is also key to have great communication between data entry staff, clinical staff and billing department, as well as appropriate training.)  Please view the following.

# 1 Monitoring Episodes/Claims To Be Billed:

This can be done daily, weekly, biweekly or monthly based on the Payer.  To monitor Medicare (PPS) claims, here are a few tracking reports:

14.03 PPS Tracking Report:  To access this report, from Barnestorm Office, click Billing > Reports > 14.03 PPS Tracking Report.  Mark these checkboxes on the report screen:  485 No OASIS, OASIS No Visit, Visit no RAP, and RAP no EOE to monitor unbilled RAPs or EOEs.    Review this report daily to ensure getting those episodes out and billed timely.  The report will give a description of why the RAP or EOE is being held.  For any clinical issues forward to Nursing Department quickly so they can resolve the issue. 

Click here for more information on the PPS Tracking Report. 

2022:  RAPs/NOAs are now required to be billed within 5 days of date of admission.  We recommend billing for RAPs/NOAs is run at least twice a week to prevent payment penalties due to late submission of RAP/NOA.  Click here for more info.

#2 Audits 

Audits are very important to get “clean” claims out the door!  It is normal to have a Clinical staff member do a clinical-audit to verify all assessments have been done, and frequencies match the orders/supplies given, and OASIS information is correct/export/accepted, F2F etc.  Next, is the billing-audit:  verifying all visits are keyed in, all supplies are keyed in and verifying the charges are correct, in addition to any other verification your agency specifies.

Options for Chart Audits:  You can do this manually, by simply printing off the audit sheet and reviewing the information; or you can use the Chart Audit feature in Barnestorm where you can mark the EOE as “in review” or “Audit Approved, release for billing.”  The tracking feature is only available on the Edit PPS Episodes screen (for PPS only).  Click here for more information on Chart Audits in Barnestorm.

#3 Billing

Once the audits are done, you are ready for billing.  This is the easiest part:  creating the claims in Barnestorm and then sending them using your normal methods to get those claims to the payer.  Next, is the most important step after the claims leave your door or “mailbox.”

 #4  Monitor! Monitor! Monitor!

Track all claims until the claim is paid.  If the claim gets rejected, you will need to review the error, then correct and resend the claim ASAP.   This may include direct contact with your intake department, authorization department or clinical staff based on the nature of the denial.

Suggestions for billing clerk:

1.  Make 2 folders labeled (ie.)  “Electronic Claims Pending” and “Paper Claims Pending.”  It is also optional to create a separate folder for each payer.

2.  Print out the transmission sheet for each batch created.  File each transmission sheet in the appropriate folder.

3.  Monitor RAP/NOA - Particularly for Medicare:  Once the RAP/NOA has been submitted, monitor the status in DDE until paid.  If the RAP/NOA denies or rejects, review the issue, correct and resubmit (if applicable) ASAP.  Again, the billing requirement is 5 days from date of service.  For nonMedicare PPS, you can do the same by checking the status on the applicable payer portal.  Once the RAP/NOA is marked as "paid," check off that RAP/NOA on the transmission list.  Once all are paid on the transmission list, you can then file or purge the list.

4.  Wait for EOE payments.  For PPS payers, track the claim status in DDE daily until the claim is paid.  Once the claim is paid, check off that claim on the transmission list.  Once all claims are paid on the transmission list, you can then file or purge the list.  If claim is rejected or denied, review the denial reason, correct and resend as soon as possible.  For PPS payers, where the claims are mailed, start tracking those at least a week after the claim is mailed, and then monitor weekly until the claim is paid.