Billing and Collections | Cash Posting | Weekly Management Reports | ICD-9 Coding Review | Quarterly On-Site Audits | Monthly Reconciliation Reports | Homecare Software Options
HPS has extensive knowledge and experience billing and collecting for multiple payer types, including the following:
- Medicare PPS
- Medicare Part B
- Medicaid (all states)
- Private & Commercial Insurance
- Veterans Administration
- Self-pay, including deductibles & co-pays
Billing & Collections
HPS will transmit Medicare RAP and Final Claims at least twice a week. Non-Medicare claims will be submitted on a monthly basis. A review of all claims for billing errors will be performed to help insure the transmission of accurate claims.
A sample of billing and collection processes includes:
- Notification of RAPs & Final Claims Due
- Daily Review of Rejected Claims
- Timely Follow-up of Unpaid Claims
- Daily Cash & Adjustment Posting
HPS will be responsible for the entire billing and collection process from the initial filing of claims to the final posting of cash and/or adjustments.
Cash posting is one of the most critical components of the billing process. HPS will download Medicare remittance advices on a daily basis and post cash on no less than a weekly basis. At the time of cash posting, differences in payment amounts for Medicare episodes will be researched in the Medicare DDE system in order to post the adjustment to the appropriate category. If adjustments are inappropriate, corrections to claims will be made in a timely manner to insure the collection of cash in an expeditious manner.
For non-Medicare payers, contractual adjustments will be recorded based on explanation of benefits (EOB) or remittance advices (RA). Any deductibles and co-pays will be transferred to the patient’s self pay accounts and statements will be sent at the time of the primary insurer’s payment. This process will help agencies reduce the possibility of self pay write-offs due to untimely submission of amounts owed.
A complete reconciliation of bank deposits to posted payments will occur on a monthly basis.
Weekly Management Reports
HPS will monitor various indicators on a weekly basis to help insure a consistent flow of information from the agency to HPS. Cash flow consistency depends on HPS receiving a certain number of Final Claim audits and information to transmit RAPs on a daily basis.
HPS will provide a weekly summary of Medicare Billing Activity which will include patient admissions and recertifications, number of Final Claim audits received, number of RAPs and Final Claims transmitted, and total cash receipts.
Analysis of this information will allow HPS and Agency management to monitor trends and also identify any factors that may negatively impact cash flow.
ICD-9 Coding Review
ICD-9 Coding has become a significant part of home health reimbursement. HPS will review every Medicare Final Claim, before it is transmitted, to insure that ICD-9 coding is appropriate for reimbursement purposes.
HPS will review ICD-9 coding to ascertain that for every discipline with a billable visit on the claim there are codes to support medical necessity of those visits.
HPS will also attempt to identify coding compliance issues such as misuse of manifestation coding and inappropriate use of V codes.
Quarterly On-Site Audits
HPS will provide quarterly on-site visits to perform independent billing chart audits and provide an in-service to agency staff based on issues noted from the previous quarter. These audits will help insure that documentation is in accordance with Medicare regulations and to provide suggestions for operational improvements as the agency grows. HPS will audit a minimum of ten percent of claims filed in the previous quarter.
These audits are to focus on the integrity of information being sent to HPS for billing and allow clinicians a time for feedback, as well as, provide them with additional education.
Monthly Reconciliation Reports
On a monthly basis, HPS will reconcile all receivable, allowance, revenue, accrual and deferral accounts. This reconciliation insures that all patient admissions are reflected in recorded revenues.
The following reports will be included in the month end reporting package:
- Management Summary
- Roll forward of all Receivable and Allowance Accounts
- Journal Entry to record all receivable and revenue activity
- Adequacy of Allowance Calculation
- Roll forward of Patient Census
- Trend Analysis of visits per episode
- Trend Analysis of Monthly Revenues
- Trend Analysis of Monthly Receivables
- Days in A/R Statistics
- Explanation of balances over 150 days old
- Cash Receipts Reconciliation
- Detail Patient Aging Reports
All accounting for receivable and revenue transactions will be summarized in one journal entry for your accounting staff to record. This month end reporting package will provide complete backup for this entry.
As requested, additional reports are available to meet your agency’s needs.
Homecare Software Options
At HPS, we customize a software solution for each individual agency based on their needs. We have various options for software utilization:
Agencies can elect to utilize HAVEN for their OASIS needs.
Homecare agency currently has clinical/billing software and HPS connects through a virtual private network (VPN) or a web portal on the internet to access the system and perform all billing, collection and reporting activities.
Homecare agency will access HPS’ clinical/billing software through a web portal to perform selected functions. Available functions are as follows:
- Patient Admission/Demographics
- Plan of Care (485)
- Visits and Supplies