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ADL DATA SYSTEMS, INC.ADL DATA SYSTEMS, INC.

BILLING ADJUSTMENTSBILLING ADJUSTMENTS

June 7, 2010June 7, 2010

11:00 am – 12:00 pm11:00 am – 12:00 pm

TRANSACTION TRANSACTION ADJUSTMENTSADJUSTMENTS

Presented by Sara Montoro

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Adjustments to be covered:Adjustments to be covered:

Days BilledDays Billed Patient Liability AdjustmentsPatient Liability Adjustments MedicareMedicare Co Insurance DaysCo Insurance Days Part B Cross-Over ChargesPart B Cross-Over Charges

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DAYS DAYS 1. Incorrect 1. Incorrect Discharge Date. Discharge Date. Billing is over 4 daysBilling is over 4 days Discharged and Billed Thru :Discharged and Billed Thru : 4/09/08 4/09/08 Correct Discharge Date : Correct Discharge Date : 4/06/08 4/06/08

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Correction Process:Correction Process:

* Select Option A – Hand Bill/Void/Transfer* Select Option A – Hand Bill/Void/Transfer

* Enter From and Thru dates* Enter From and Thru dates

* Select Paysource to void and click OK* Select Paysource to void and click OK

* Verify the Net Bill amount and click OK* Verify the Net Bill amount and click OK

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* Review the Ledger* Review the Ledger* Create a R&B batch in Ancillary to delete the incorrect days displayed as unbilled and enter a second * Create a R&B batch in Ancillary to delete the incorrect days displayed as unbilled and enter a second

line to capture the correct number of daysline to capture the correct number of days

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Note: Medicaid Claims that have already been submitted are adjusted in the Re-Billing fileNote: Medicaid Claims that have already been submitted are adjusted in the Re-Billing file

* Run the Billing process

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2.2. Incorrect Admission DateIncorrect Admission Date. . Billing is short 1 day Billing is short 1 day The resident was admitted on 4/25/08 instead of 4/24/08The resident was admitted on 4/25/08 instead of 4/24/08

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Correction process:Correction process:* Void days already billed using Option A * Void days already billed using Option A * Enter From and Thru Dates* Enter From and Thru Dates* Select Paysource to void and click OK* Select Paysource to void and click OK* Verify the Net Bill amount and click OK* Verify the Net Bill amount and click OK* Create a R&B charge for missing days in the Ancillary Edit Batch function* Create a R&B charge for missing days in the Ancillary Edit Batch function* Run the Billing process* Run the Billing process

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Patient LiabilityPatient Liability

3. Billed incorrect Liability Amount 3. Billed incorrect Liability Amount

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Correction process:Correction process: * Select Option K – * Select Option K – NAMI/Budget bill adjustment NAMI/Budget bill adjustment and click OKand click OK * Enter the amount billed in the Budget field* Enter the amount billed in the Budget field * Enter the correct amount in the NAMI Bill field and click OK* Enter the correct amount in the NAMI Bill field and click OK * Review the Ledger* Review the Ledger * Verify the Expected Income & Budget screen and History fields for * Verify the Expected Income & Budget screen and History fields for

the correct liability amountsthe correct liability amounts

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4. Billing without Patient Liability Amount4. Billing without Patient Liability Amount

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I. Correction process:I. Correction process:* Select Option K – * Select Option K – NAMI/Budget Bill AdjustmentNAMI/Budget Bill Adjustment* Enter Liability Amount in the BUDGET field* Enter Liability Amount in the BUDGET field* Verify the Net Bill Amount and click OK* Verify the Net Bill Amount and click OK* Review the Ledgers* Review the Ledgers

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** If all accounts need to be corrected then:** If all accounts need to be corrected then:

Use Retro Billing to capture all liability amounts missing from a Use Retro Billing to capture all liability amounts missing from a Billing CycleBilling Cycle

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II. Retro billing process:II. Retro billing process:

** Select the Medicaid tab Select the Medicaid tab

* Select option 8 - MCAID Retro Billing * Select option 8 - MCAID Retro Billing

* * Enter the “last date” of the billing, enter the number of days Enter the “last date” of the billing, enter the number of days

* Select Bill Budgets F option* Select Bill Budgets F option

* In Paysources to include remove * In Paysources to include remove if Pending Medicaid claims were not if Pending Medicaid claims were not

includedincluded, click OK, click OK

** Select option 2- Sales Journal and click OK Select option 2- Sales Journal and click OK

The Sales Journal report displays all missing patient liability amountsThe Sales Journal report displays all missing patient liability amounts

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* * Select option 10 – Post bills to ledgers Select option 10 – Post bills to ledgers * Enter Posting Date, Period Ending Date, check Medicaid, Retro and click OK* Enter Posting Date, Period Ending Date, check Medicaid, Retro and click OK* Review ledgers* Review ledgers

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MEDICAREMEDICARE

5. Billed Incorrect Number of Days. 5. Billed Incorrect Number of Days. Billed 9 days to Medicare + Co-days instead of Private.Billed 9 days to Medicare + Co-days instead of Private.

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Correction process:Correction process:* * Use Option A and enter From and Thru datesUse Option A and enter From and Thru dates* Void Medicare * Void Medicare (paysource E)(paysource E) * Transfer Co-Ins from Private * Transfer Co-Ins from Private (paysource F)(paysource F) to Medicare to Medicare (paysource E or any other (paysource E or any other

paysource billed as co-ins)paysource billed as co-ins)

**Verify Medicare Paysource screen Co-Ins Code and correct the End DateVerify Medicare Paysource screen Co-Ins Code and correct the End Date

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6. Billed Medicare instead of Medicaid6. Billed Medicare instead of Medicaid

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Correction Process:Correction Process:

* * Use Option A to Void Medicare – EUse Option A to Void Medicare – E

* Enter from and Thru dates* Enter from and Thru dates

* Select Medicare paysource* Select Medicare paysource

* * Verify that the Net Bill matches the Ledger AmountVerify that the Net Bill matches the Ledger Amount

* Verify the Medicare Paysource screen has the correct End Date* Verify the Medicare Paysource screen has the correct End Date

* View ledger* View ledger

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7. Billed wrong RUG Scores to Medicare 7. Billed wrong RUG Scores to Medicare

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Correction Process:Correction Process:* * Use Option A to void Medicare and bill Medicare Co-DaysUse Option A to void Medicare and bill Medicare Co-Days* * Verify the Net Bill amount to the Ledger on both screens Verify the Net Bill amount to the Ledger on both screens (Edit Room (Edit Room

Allowance Amt.)Allowance Amt.)

* Edit MDS Tracking and Bill * Edit MDS Tracking and Bill

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Co-InsuranceCo-Insurance

8. 8. Billed Six Co-Days instead of 26 Co-DaysBilled Six Co-Days instead of 26 Co-Days

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Correction Process:Correction Process:* Use Option A to create missing Medicare Co-Days* Use Option A to create missing Medicare Co-Days* Enter From and Thru Dates* Enter From and Thru Dates* Select Paysource in Co-Insurance field* Select Paysource in Co-Insurance field* Review the Ledger* Review the Ledger* Correct the claim in Omni Pro* Correct the claim in Omni Pro

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9. Adjustment of billed Co-Days from Insurance to Medicaid 9. Adjustment of billed Co-Days from Insurance to Medicaid

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Correction process:Correction process:* Use Option A to void Co-Day Paysource* Use Option A to void Co-Day Paysource* Enter From and Thru Dates* Enter From and Thru Dates* Select Paysource in Coinsurance field* Select Paysource in Coinsurance field* Verify that the Net Billed matches the Ledger * Verify that the Net Billed matches the Ledger

Amount Amount

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* Review Special Data – Unbilled Days screen* Review Special Data – Unbilled Days screen* Review the Ledger * Review the Ledger * Verify the Paysource set up screen and bill Medicaid* Verify the Paysource set up screen and bill Medicaid

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PART B CROSS OVER CHARGESPART B CROSS OVER CHARGES

10. 10. Billed Part B and Cross Over when resident had no Part BBilled Part B and Cross Over when resident had no Part B

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I. Part B correction process:I. Part B correction process:* Use Option A to void Part B Charges* Use Option A to void Part B Charges* Enter From and Thru Dates* Enter From and Thru Dates* Select T for Part B and click OK* Select T for Part B and click OK* Verify the Net Bill to the Ledger Part B Amount and click OK* Verify the Net Bill to the Ledger Part B Amount and click OK

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II. Cross over correction:II. Cross over correction:* Use Option A to void Part B Charges* Use Option A to void Part B Charges* Enter From and Thru Dates* Enter From and Thru Dates* Select the Paysource Code used for Cross-over and click OK* Select the Paysource Code used for Cross-over and click OK* Verify the Net Bill to the Ledger Cross-Over Amount * Verify the Net Bill to the Ledger Cross-Over Amount (Delete any other charges not related to this adjustment. Ex: R&B, etc.)(Delete any other charges not related to this adjustment. Ex: R&B, etc.)* View the Ledger* View the Ledger* Remove the Part B flag from the Paysources screen* Remove the Part B flag from the Paysources screen

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Reports that help you identify accounts that may Reports that help you identify accounts that may need Adjustments:need Adjustments:

1.1. A/R Schedules Report - review file Name PTBALL reports for UnbilledA/R Schedules Report - review file Name PTBALL reports for Unbilled

Charges.Charges.

2. 2. Ledger for the Month – Patient Sales Report Ledger for the Month – Patient Sales Report ((PTLSUMPTLSUM)) for all Unbalanced for all Unbalanced

Accounts displaying an *.Accounts displaying an *.

3. Print Registry - with the option NONE selected to include Billed Charges to3. Print Registry - with the option NONE selected to include Billed Charges to

view any missed Unbilled Charges.view any missed Unbilled Charges.

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The End The End