Powerful Healthcare Solutions
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 performed by MJS & Associates, LLC. But we do much more before the claim is determined to be properly developed.
Claim DNA activities performed by your assigned Account Management Team member include, but are not limited to, confirmation of the following:
RAP (Request for Anticipated Payment)
Payor eligibility check with demographic match-up
Pre-RAP document review
Type of Bill, Admission/Start Date of Care Origin of Admission, Discharge Status checked
Condition Code 47 entered for Transfer Patient
Face-to-face certification with required supporting documentation in place and physician verification to plan of care physician
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 dating on all documents
The Account Management Team has access to MJS RNs 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 is also ready to roll-out billing under the new Patient Driven Grouping Model (PDGM), the 30-day period combination of subcategories that will place Medicare payments into 215 different payment groups in 2020.