Medeasy for Windows - User's Guide

Chapter 5
RECEIVABLES - PART A CLAIMS

The following is a detailed description of MEDICARE PART A CLAIMS menus. Once you master the navigation and screen set up you can apply your skills to other menus in RECEIVABLES. As usual the accuracy of data depends on your knowledge of payer reimbursement rules.
1. MEDICARE PART A CLAIMS

1. Add New Claim & Modify Existing Claims
The first two submenu items are identical in navigation and functionality. The only difference is that when adding claims, the system allows you to manage claims for all patients. While modifying, however, you may choose from a list of patients for which a claim already exists.

General - Pay close attention to tabs, buttons and menu options. For example, you may move to the next patient by using the navigational buttons provided on the right hand side of the screen.
Also note the information flow. Refer to the sample screen. Each row of information represents a service period (claim.) The "PATIENT" tab will display all claims for specific patient, either highlight or place the cursor on a row of information (one claim) and view claim detail in the other tabs.

Now you may begin to create new claims for the selected patient. Click on ADD NEW CLAIM button (or activate from menu) to begin. Make sure the patient HIC number is on file (see PATIENT Menu, Patient Information). Enter service dates; designate a bill type for Medicare Part A claims- usually 211, 212, 213, or 214 - and OK. When you create a new claim, the software immediately prompts you to complete the "Claims" tab:

MedEasy will pull the admission date for 211 and 212 bill types, which is the same date as beginning service date.

Enter ‘hospital qualifying’ dates. Hit either Tab or Enter key to move to the next data entry field.

To enter patient status, admission type and admission source, double click on the blank box to reveal codes and click on your selection. Tab or hit Enter key to move to the next data entry field.

Total Medicare days will be calculated based on claim service dates and status at end of the month. Refer to the information available on each patient to determine days used, full days and co-insurance days. Tab or hit Enter key to move to the next data entry field.

To enter Diagnosis and Condition codes, double click on each box and click on your selection. Tab or hit Enter key to move to the next data entry field.

To access Physician UPIN database, double click on the data box and click on your selection. Tab or hit Enter key to move to the next data entry field.

Add remarks specific to this claim.

Proceed to "CHARGES" tab.

Click on ADD CHARGE button and click on a revenue code to select. To select multiple revenue codes, hold down the Control (CTRL) key and click on desired items. Click on OK.

If revenue codes and their corresponding rates are in place (via MAINTENANCE), then the system will reflect those rates in Rate column. Additionally, if you preloaded Medicare designated revenue codes 110, 120 and 130 for accommodation charges, the software will calculate the number of days in the Unit column. Otherwise, you may manually enter or type over existing rates and units.

To delete a charge, highlight the charge and click on DELETE CHARGE button.

Proceed to "HIPPS" tab.

Click on ADD HIPPS button to begin.

The revenue code for HIPPS is 0022 and is designated by Medicare. Unless otherwise instructed, do not change this code otherwise your transmission will not be successful.

Double click on RUG III and Modifier data entry boxes and select a code for each field.

Enter Units and <tab> or <enter>.

Enter the assessment date for RUG III code and <tab> or <enter>.

Click OK to save.

Note that units of accommodation charge must equal to total units of HIPPS records.
Proceed to RECEIVABLE tab to calculate the receivable and post to G/L, one claim at a time. To batch process calculation and posting, go to the RECEIVABLE menu, choose a payer, and select CALCULATE RECEIVABLE and/or POST TO G/L from the submenu.

a. Verify the claim information and mark it as complete. Locate the check box on the top right hand corner of each tab and click on the box to complete the claim. This means that the claim is ready for calculating receivable amounts, transmission, and posting to the General Ledger. The system will check certain data fields for completion, before accepting the claim.

b. Click on CALCULATE RECEIVABLE button. MedEasy will calculate the receivable amount based on Medicare formulae. You may change the receivable amount if special circumstances exist. Refer to "Modify Receivables" section for Part A claims.

c. Click on POST TO G/L button to post the claim. You are required to enter post date for the claim. Consult your accounting department regarding posting dates.

d. You can review all the claims created from the "PATIENT" tab, below.

To modify a claim, mark the claim as incomplete, enter changes and complete the claim. However, after the claim is already posted some information that will affect the receivable amounts cannot be changed. Refer to "Adjusting a posted claim" to make changes for those fields. Note "Bill Date" column. A blank field in that column means that the claim has not been transmitted. You may correct a claim and resubmit it by clearing the bill date for that claim.
Changing Service Dates
To change service date, mark the claim as incomplete.

a. On the "Patient" tab, Select the claim (click on the row of information you wish to change service dates.) On other tabs, proceed to next step.

b. Go to the menu bar and select CLAIM, then click on CHANGE SERVICE DATE submenu.

The current service dates will display in dialog box, you can type over the correct service dates and click OK.
Note that you need to mark the claim as complete once you are done.
Modifying Receivables
You may change the receivable amount if special circumstances exist. You should consult experts in determining how to best handle the circumstances. This feature is password protected.
To modify receivable amounts calculated by software,

a. On the "Patient" tab, select the claim (click on the row of information you wish to modify receivable.) On other tabs, proceed to next step.

b. Go to the menu bar and select CLAIM, then click on MODIFY RECEIVABLE submenu.

The software allows you to type over the current receivable amounts.
Deleting Claims
To delete a claim:

a. On the "Patient" tab select a claim (click on the row of information you wish to delete.) On other tabs, proceed to next step.

b. Go to the menu bar and select CLAIM, then click on DELETE SELECTED CLAIM submenu.

MedEasy will prohibit deletions if:
1. Claim has been submitted for payment.
    Remedy: Delete the bill date.
2. A payment record exists.
    Remedy: After you verify the payment, you may decide that the payment was posted
    incorrectly. You may delete the payment and then return to this screen to delete the
    claim.
3. The claim is posted to G/L and the accounting period is closed.
    Remedy: Since the accounting period is closed, we cannot delete the claim. However, if
    the claim has an error, after you reverse the claim (refer to Adjusting a posted claim),
    you can void the claim by entering zeros in all rate fields. Then re-calculate the
    receivable. All receivable amounts should become zero.
Adjusting a Posted Claim
After consulting your accountant, follow these steps to make an adjustment to a posted claim.

On the "PATIENT" tab, select a claim (click on the row of information you wish to adjust.) On other tabs, proceed to next step.

Click on the ADJUSTMENTS menu. There are five adjustments option for Part A claims.

1. ADJUST RECEIVABLES
If adjustment is necessary due to changes of information other than claim information, for example, patient income or facility co-insurance rate, first make the necessary changes in patient or facility screen. Then use this option to have those changes reflect in claim receivable amounts.
2. ADD ANCILLARY CHARGE
After the claim is posted, if new ancillary charge needs to be added to this claim, use this option to add new charge.
3. DELETE ANCILLARY CHARGE
After the claim is posted, if an ancillary charge needs to be deleted from this claim, use this option to delete the charge. You have to select the charge that you would like to delete in "CHARGE" tab before click on ADJUSTMENT menu.
4. MANUAL ADJUSTMENT
On rare occasions when you need to allocate a receivable among payer sources different than the way software calculates the receivables, you may do so via Manual Adjustments. The total receivable should remain the same. This option does the same thing that "Modify receivable" does before posting the claim. This option is password protected.
5. REVERSE CLAIM
Use reverse claim to reverse the entire claim (both revenue and receivable ) After you make changes to the claim, you need to CALCULATE the claim before posting again.
You will need to enter the new post date for all the options above. Consult your accounting department regarding posting dates and adjusting receivables.
5.1.2 Calculate Receivable
Before you calculate receivables, review all claims for the month and complete claims. Once you mark the claims as complete, you are ready to calculate accounts receivable for a batch of claims. From the RECEIVABLES menu, select CALCULATE RECEIVABLE. Enter the desired month and year. Click on OK. The system will confirm the total number of claims on the screen.
5.1.3 Post Claims to G/L
After claims are calculated, you should use this option to post all the claims for specific month and year. From the RECEIVABLES menu, select POST CLAIMS TO GL. Enter the desired month and year, as well as posting date. Click on OK. The system will confirm the total number of posted claims on the screen.
5.1.4 Print UB 92 – Part A
Enter the service date, select either one patient or all patients for those service dates, UB92 form will be printed. MedEasy does not require you to feed the pre-printed UB 92 form.
5.1.5 Print Ancillary Charge Log
Select this menu item to print claims ancillary charges for a given period. Enter the desired date parameter and click OK. If you requested a report for multiple months, note that each new month begins on a new page. Note that charges in charge master will not appear here. To view charges in charge master, use REPORT menu and then CENSUS reports.
5.1.6. Receivable Log
Select this menu item to print claims receivables log for a given period. Enter the desired date parameter and Click OK. If you requested a report for multiple months, note that each new month begins on a new page.
5.1.7. Claim Status Log
Select this menu to print claims receivables information for Medicare, Medicaid co-insurance, and private co-insurance separately for a specific month and year. You can enter the status of the collection in the "Remark" field at the claim screen. This field will be printed on this report to help you follow up on your collection attempts.
5.1.8. Transmission Log
Select this menu item to view list of claims transmitted using MedEasy software. Enter the desired transmission date, choose the transmission time, and Click OK.