Home health billing requires considerable review of documentation, signature, and dates that must be in place before the final claim is submitted. Determining that the source documents are in place, complete, properly signed and dated is the first step in the Claim DNA process performed by MJS & Associates, LLC. But we do much more before the claim is determined to be properly developed.
Since Patient Driven Grouping Model (PDGM) has been in effect for Medicare claims, Claim DNA activities by MJS are even more important for the accuracy and timeliness of billing. The 30-day claim period re-alignment requires careful attention to timeframes and data completeness to establish a clean and efficient revenue cycle. MJS also makes certain that eligibility is checked with the payor and that demographics are matched to prevent costly rejections.
Claim DNA activities that are performed by your assigned Account Management Team member include, but are not limited to, confirmation of the following:
RAP (Request for Anticipated Payment) – changes are coming in January 2021! We are ready!
· Initial admission order is in place from physician (verbal or written for 2021)
· OASIS is completed (signed and dated by author)
· 1st billable visit is complete (signed and dated by author)
· RAP is timely submitted (within 5 days of SOC beginning January 1, 2021)
We will track your admissions to aid you in getting the RAP rolled out timely!
Final Claim
For Texas providers, confirmation that appropriate tracking number for review Choice Demonstration project is in place and entered to the claim!
For all providers, the Claim DNA for the Final Claim includes:
· Face-to-face certification with required supporting encounter/documentation in place completed by qualifying physician or practitioner
· All orders and therapy evaluations signed and dated
· Billable skilled intervention is documented on the OASIS
· Frequency of visits matched to orders OASIS transmission validation to OASIS on file
· Clinical note to support each billed charge
· Signatures and dates on all documents
· Type of Bill, Admission/Start Date of Care Origin of Admission, Discharge Status checked
· Condition Code 47 entered for Transferred Patient
· And much more!
The Account Management Team has access to MJS RN's for answers to questions regarding eligibility and medical necessity. This team approach has proven invaluable to the clients for whom we bill. Preventing billing mistakes will prevent denials!
MJS also provides billing and collection activities for home health clients with other service lines including private pay skilled services and non-skilled service, pediatric private duty hourly services, and others.
Collection efforts are greatly reduced by the MJS Claim DNA processes; however, all claims submitted by MJS are confirmed for clearinghouse acceptance and clearance. Claims are followed every day for status in the payer system. Once in place, claims are tracked routinely until the claim reaches the payment floor.
MJS also offers collection activities for service that are not billed by MJS. This recovery is generally based upon a percent of collected amounts.
Contact us for your outsourcing needs!