Part B Claims

Chapter 5
RECEIVABLES - PART B CLAIMS

5.2.1. 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.) "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.

a. 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 B claims- usually 221, 222, 223, or 224 - and OK. When you create a new claim, the software immediately prompts you to complete the "Claims" tab:

b. Enter date of onset. Tab or hit Enter key to move to the next data entry field.

c. Enter therapy dates, visits, and units. Tab or hit Enter key to move between data entry fields.

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

e. 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

f. Add remarks specific to this claim.

Proceed to "HCPCS" tab.
a. Click on ADD HCPCS button to begin.
b. Choose a revenue code from the list box on the left. If the code you want is already selected then click another code and then click the code you want to load the revenue field on the right.
c. Enter a Modifier. In some instances the software will insert the appropriate Modifier.
d. Double click on the HCPCS data entry box and select a code.
e. Enter number of visits.
f. Enter Units
g. Enter the Service Date for HCPCS code.
h. Click OK to save.
i. To copy HCPC, highlight the HCPC and click on COPY HCPC button. A new HCPC   record will be created for you with same information as the one you copied from except the "Service Date". Enter the service date to complete the record.
j. To delete a HCPC, highlight the HCPC and click on DELETE HCPC button.
Proceed to the 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.

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. ote that you need to mark the claim as complete once you are done.
Deleting Claims
To delete a claim:

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

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 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 Posted Claims
After consulting your accountant, follow these steps to make adjustment to a posted claim.

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

Click on ADJUSTMENTS menu. There are four adjustments option for Part B claims.

ADD HCPC RECORD
After the claim is posted, add new HCPC Record as needed.
DELETE HCPC RECORD
Use this option to delete a HCPC record from a posted. You have to select the HCPC that you would like to delete in "HCPCS" tab and then go to ADJUSTMENT menu.
MANUAL ADJUSTMENT
On rare occasions when you need to allocate a receivable among payer sources other than the way the software calculates the receivables, you may do so via Manual Adjustments. The total receivable should remain the same. This option is password protected.
REVERSE CLAIM
Use reverse claim to reverse the entire claim (both revenue and receivable sides.) After you make changes to the claim, click on CALCULATE button to recalculate the claim before posting again.

You need to enter the new post date for all the options above. Consult your accounting department regarding posting dates and adjusting receivables.

5.2.2. 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.
5.2.3. 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.
5.2.4. Print UB92 – Part B
Enter claim service dates, 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 UB92 form.
5.2.5. 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.
5.2.6. 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.
5.2.7. 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.
5.2.8. Transmission Log
Select this menu item to view a list of claims transmitted using MedEasy software. Enter the desired transmission date, choose the transmission time, and Click OK.