FINANCIAL - Billing - Invoice Processing: [Medicare PPS Episode cycle] [FINAL CLAIM]
Click the [Corrective Action] button in the PENDED CLAIMS section. A second browser will open and display a PDF report. The report is intended as a follow-up document to assist you in resolving conditions that caused a FINAL CLAIM to be pended (placed on-hold). There are three main sections in the report; a FINAL LUPA section, a FINAL section and an UNPROCESSED CLAIMS section.
The FINAL LUPA section of the report contains Patient Name, Patient ID#, Claim 'From' Date, Claim 'To' Date, Type of Bill, HIPPS Code, HHRG Reimbursement Amount, and six columns indicating specific follow-up.
POC Needed: If YES, then a Plan of Treatment (485) needs to be entered into patient clinical record.
1st Visit Needed: If YES, then a billable visit on SOC date needs to be entered into patient transaction record (where discipline is not HHA).
POC MD Sign Needed: If YES, then the Plan of Treatment (485) is outstanding; awaiting the physician signature.
VO MD Sign Needed: If YES, then a Supplemental (Verbal) Order is outstanding; awaiting the physician signature.
Ther Over: If YES, then the asmt M0825 response is NO but the system has detected a therapy visit count that warrants a M025 response of YES.
LUPA Over: If YES, then the asmt billing status had been previously indicated as a 'No-RAP LUPA' but the system has detected a visit count over the LUPA Threshold.
The section footer includes Patient Count, Claim Count and HHRG Reimbursement Amount Total.
The FINAL section of the report contains Patient Name, Patient ID#, Claim 'From' Date, Claim 'To' Date, Type of Bill, HIPPS Code, HHRG Reimbursement Amount, and five columns indicating specific follow-up.
POC Needed: If YES, then a Plan of Treatment (485) needs to be entered into patient clinical record.
POC MD Sign Needed: If YES, then the Plan of Treatment (485) is outstanding; awaiting the physician signature.
VO MD Sign Needed: If YES, then a Supplemental (Verbal) Order is outstanding; awaiting the physician signature.
Ther Not Met: If YES, then the asmt M0825 response is YES but the system has detected a therapy visit count that warrants a M025 response of NO.
Ther Over: If YES, then the asmt M0825 response is NO but the system has detected a therapy visit count that warrants a M025 response of YES.
The section footer includes Patient Count, Claim Count and HHRG Reimbursement Amount Total.
The UNPROCESSED CLAIMS section of the report contains Patient Name, Patient ID#, Claim 'From' Date, Claim 'To' Date, Type of Bill, HIPPS Code, HHRG Reimbursement Amount, and four columns indicating specific follow-up.
Asmt Needed: If YES, then an episode-establishing assessment (type 1 or 4) needs to be entered into patient clinical record.
Tran Lock Date Needed: If YES, then an episode-establishing assessment (type 1 or 4) is present in the patient clinical record but it is not VALIDATED (locked/ready for transmission).
LUPA Visit Count Exceeded: If YES, then the asmt billing status had been previously indicated as a 'No-RAP LUPA' but the system has detected a visit count over the LUPA Threshold.
Therapy Threshold Exceeded: If YES, then the asmt M0825 response is NO but the system has detected a therapy visit count that warrants a M025 response of YES..
The section footer includes Patient Count, Claim Count and HHRG Reimbursement Amount Total.
Please click Preview Attachment link at the right to view a sample FINAL CLAIM Corrective Action Report.