Year End Billing

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(No Transcript)
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Year End Rate Changes

• Lunch and Learn
• Presented By
• Debbie Buxton

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Topics For Discussion

• Rate Changes
• Billing Code Rates
• Recurring Rate Change
• Patient Responsibility
• Special Rate Change
• Medicare Rates
• Coinsurance Rate
• Therapy Limit

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Rate Change

• When the facility has a Room Board change and
  they are being pre-billed, the following steps
  must be taken
• Enter the new Room Board rates under Billing
  1st/3rd Party gt Table Maintenance gt Rates
• Make sure to create a new rate line with the new
  effective date and rate (example if new rates
  take effect on the first of the new year your
  effective date would be 01/01/200x
• Generate the Monthly Billing
• In our example of new rates taking effect on
  January 1st, during the December billing verify
  any December room and board charges use the old
  rate
• Review the billing register
• Update the monthly billing register
• Generate the Pre-Billing
• In our example of new rates taking effect on
  January 1st, verify the January pre- billed
  charges are using the new rate
• Review the billing register
• Update the Pre-bill register

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Billing 1st/3rd Party gt Table Maintenance gt
Rates
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Billing Code Changes

• When the facility has new rates that effect any
  ancillary charges (therapies, beauty shop etc.)
  the following steps must be taken.
• Enter the new rate under the billing code with an
  effective date.
• Modify Default amount across companies or
  the Import Rates by HCPCS can also be used
• 2. Change the standard rate on each payor type
  line as needed.

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Billing 1st/3rd Party gt Table Maintenance gt
Billing Code
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Modify Default Amount Across Companies or Import
Rates by HCPCS
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Recurring Charge Increase

• This is used when billing codes are assigned to
  individual residents as a recurring charge.
• 1. Generate the Monthly Billing Verify old rate
• 2. Review the billing register
• 3. Update the monthly billing register
• 4. Enter the new recurring charge amount under
  recurring charge increase. If using the Create
  mode the new rates can be entered before the
  generate monthly billing
• 5. Generate the Pre-Billing Verify New Rate
• 6. Review the billing register
• 7. Update the Pre-bill register

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Billing 1st/3rd Party gt Table Maintenance gt
Recurring Charge Increase
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Patient Responsibility Changes

• When the facility receives notice that a
  residents responsibility has changed and they
  are being pre-billed, the following steps must be
  taken
• 1. Enter the new responsibility amount under the
  residents profile.
• 2. Generate the Monthly Billing
• 3. Review the billing register
• 4. Update the monthly billing register
• 5. Generate the Pre-Billing
• 6. Review the billing register Verify the new
  rate
• 7. Update the Pre-bill register

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Resident Special Rates

• 1. Enter the new special rate. Make sure that you
  enter a through date to end the current rate
• 2. Generate the Monthly Billing
• 3. Review the billing register
• 4. Update the monthly billing register
• 5. Generate the Pre-Billing
• 6. Review the billing register verify new rate
• 7. Update the Pre-bill register

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Billing 1st/3rd Party gt Table Maintenance gt
Resident Special Rates
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Medicare Rates

• The new Medicare rates can be entered when they
  are received.
• Note the new rates must be in the CMI
  table before billing is done for the month that
  the new rates take effect.
• 2. You must know what CMI code your facility
  uses. CMI code can be found by going to Clinical
  gt Minimum Data Set gt Table Maintenance...
• 3. The Medicare rates are changed in the CMI code
  table

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Billing 1st/3rd Party gt Table Maintenance gt
RUG-III/CMI Master File
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Medicare Co-insurance Rate

• Medicare Co-insurance for 2008 is .
• 1. The new Medicare Co-insurance rate must be
  entered before the Monthly Generate Billing is
  done for the month that the new rate takes effect.

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Billing 1st/3rd Party gt Table Maintenance gt
Parameters
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Therapy Limits

• Medicare Therapy Limits for 2008 is .
• 1. The new therapy limits must be entered before
  Updating ANY therapy charges for 2008.

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Billing 1st/3rd Party gt Table Maintenance gt
Parameters
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Thank you for attending this session.
Debbie Buxton Support Specialist (716)
537-2820 debbieb_at_getaod.com