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HomeCare Billing

 

 

Users with Billing permissions may access the Billing center from the main menu. The Billing Tab contains two main categories:

  • The InvoiceTab which allows users to bill and manage Invoice payers.
  • Managed Care/Other Insurance allows for the creation, billing and updating of all managed care payers.

 

The Invoice Tab contains three submenus:

  • Create Invoices – Used to create invoices for private pay and payers billing on invoices.
  • Outstanding Invoices – Once invoices are created they move into the outstanding invoice page for review and submission.
  • Invoice History – Is used to view and update invoices. Features include the ability to view existing client invoices; post and view payments and adjustments.

 

 

Create Invoices

On the “Create Invoice” option, select the Branch the user wishes to generate invoices for, select the payment source, and the ‘From’ and ‘To’ date. The user has the option to select “Ignore Already Billed Tasks” which removes Tasks that may be associated to another invoice and then select “Generate” once parameters are entered. This generates a list of all clients with tasks that meet the criteria. Client invoices that contain an overlapping date range will appear in orange within the list.

 

By default, only the invoices that do not have an overlapping date range will be selected. Overlapping invoices may be manually selected for invoice creation. Users have the option to hide overlapping invoices by checking the “Exclude” box.

 

Billers may individually enter the Invoice Date, Due Date or select to apply the same dates to all selected invoices. Payment Terms default to the payment source set up but may be adjusted. Once all desired invoices are selected, select “Create Invoices.” This creates and moves the invoices to the Outstanding Invoice page. Select “Go to Outstanding” to quickly maneuver to the page showing outstanding invoices or the user can also go to Outstanding Invoice by selecting Billing/Invoice/Outstanding Invoices.

 

 

Outstanding Invoices

Select the Branch and Payment Source and select “Generate” to pull the created Invoices. Filter by Text will filter the generated list.

 

The generated invoices display the following summary information:

 

Invoice #, MRN, Client Name, Is Verified, Invoice Date, Due Date, Amount Due, Net Due, and the invoice Date Range. In addition, options to “Print” the Outstanding Invoice List or “Export” the list to Excel exist.

 

Invoices that are unverified have the following actions: to “Print”, “Verify/Edit” the Invoice or “Delete.”

 

Select the client Name to open the Invoice for verification.

 

The Edit Invoice page displays the details of the invoice and provides editing as needed. Required fields are indicated with a red asterisk (*).

 

The top sections display the payment source and date range of the invoice along with modifiable input of terms, date and due date. The Client Address displays from the Client Profile. The Billing address defaults to the client’s address but may be updated to other contact payers.

 

The lower half of the invoice will display billing line items. The Quantity and Rate are editable by selecting the field.

 

 

The last section provides the ability to add custom service charges. Select the “Add Custom Service/Tasks” to enter the applicable charges. Add any applicable tax.

  • Select “Save” to complete the verification.
  • “Save & Print” to complete and print the invoice.
  • “Close” cancels any changes.

 

Verified Invoices contain a green check mark in the Verified column. Once verified, a selection field is activated, and the available actions are updated with additional options of “Send” and “Receive Payment.”

 

There are several options available to submit Invoices to Payment Sources.

 

Under Actions:

  • The “Send” option provides the ability to Email the invoice to a payer.
  • “Print” provides the ability to individually print an invoice for mailing. Once printed, the user updates the invoice status by selecting Mark as Submitted.

 

From the Invoice list page:

  • Multi-Select Invoices and select “Bulk Print.” The user will have the option to combine into a PDF file, or a Zip file. Either choice will compile the invoices for selection under Reports/Completed Reports.
  • Once printed, update the Invoice status by selecting and Marking as Submitted.

 

 

Invoice History

The Invoice History page contains a list of a client’s invoices. For convenience, a new invoice may be added by selecting “New Invoice” at the top of the page. The “Expand” button will expand the list over the invoice summary at the top. Once an invoice is selected, a summary is displayed in the top section of the page with the options to either “Post Payment” or “Post Adjustment.”

The information provided in the list includes: Invoice Number, Date Range, Verified, Date, Due Date, Status, Total Due, Total Payments, + Adjustments, – Adjustments, Balance Remaining and Action.

 

Options under the Action column include:

  1. Print – Provides the ability to individually print an invoice for mailing.
  2. Verify/Edit – Confirms the invoice if it is in a created status.
  3. Send – Provides the ability to email the invoice to a payer.
  4. Receive Payment – Provides ability to post payments.
  5. Delete – Removes the Invoice.

Post Payment contains two required fields:

  1. Amount – Enter the amount of the payment. The system defaults to the net due, update as needed.
  2. Date – Enter the date of the applied payment.

 

Post Adjustment contains three required fields:

  1. Amount – Defaults to the invoice balance. Update as needed.
  2. Date – Indicate the date of the adjustment.
  3. Adjustment Code – Indicate the adjustment reason.

 

Invoice Quick Reports

 

To the right of the client information on the Invoice History allowing the user to view “Activity Logs” showing when the invoice was updated and by whom.

 

 

Managed Care/Other Insurance

The Managed Care/Other Insurances category contains four sub-menus:

  1. Create Claims – Used to create claims for payers billing UB04, HCFA 1500 or ANSI Text File.
  2. Outstanding Claims – Once claims are created they move into the outstanding claims page for review and submission options.
  3. Claims History – View and update claims. Features include the ability to view existing client claims; post and view payments and adjustments; view the claim in UB04, HCFA 1500 or ANSI format; update claim status’ as well as create a new claim.
  4. Claim Submission History – Ability to view submission date, batch number, clients included in a batch and claim responses.

 

Create Claims

Billing/Managed Care_Other Insurances/Create Claims

 

Select the branch, payment source(s) and date range for which claims are being created. Then select “Generate” then the system will generate a list of claims that match the requested parameters.

 

Claims identified as having overlapping claim dates will be highlighted in orange. These claims may be excluded from the list by selecting “Exclude Overlapping Claims.”

 

Select the claims to be created and select “Create Claims.” This action moves the claims into the Outstanding Claims page. Users may select the quick link “Go to Outstanding” to navigate to the claim list.

 

 

Outstanding Claims

The outstanding claim list will display all generated claims requiring verification to bill. The summary list contains the Client Name/MRN/Claim Date Range and the 4 verification pages of the claim (detail/visit/supply/verified). The last column is the print icon for viewing and downloading the claim.

 

Selecting the Client Name opens the claim for verification.

 

Step 1-Demographics

 

Required field completion includes:

  1. Facility & Bill Type – This defines what type of bill the invoice is. For example: First claim, continuing claim.
  2. Client Information – Includes Client Name, Address, DOB, Gender and Client Record #.
  3. Start and End Dates – Indicate the date range of the claim.
  4. Admission Date & Source – Start of Care date and where the referral originated from.
  5. First Billable Visit – The first billable visit in the claim.
  6. Client Status – Client’s status during the claim date range.
  7. Diagnoses –  A Primary Diagnosis is required. Nonrequired fields include Additional Diagnoses, condition codes, and remarks. Ensure population of these if required by the payer.

 

Step 2-Verify Insurance

 

Insurance Details pull from the client file. Locator Information (UB or HCFA): Add/Edit locator information as needed. The values displayed pull from the payment source setup. If changes have been made to the payer select “Reload Locators and Providers” to pull the new requirements into the claim.

 

The lower half of the screen displays all rates that have been loaded for the insurance. “Add Additional Task Rates” or “Edit” or “Delete” existing task information as needed.

 

Step 3-Verify Visits

 

The claim date range displays at the top of the page for reference. Tasks group into categories.

 

  1. Billable Tasks – Lists all completed tasks that fall within the claim date range. All billable tasks are selected by default. Task description and diagnosis pointers may be edited.
  2. Incomplete Tasks – Displays all billable outstanding tasks that fall within the date range.
  3. Unauthorized Tasks – Lists all completed tasks that fall outside authorization parameters. Users may elect to ignore the authorization warning and bill anyway.
  4. Tasks with no associated rate – Indicates tasks that were completed that are missing insurance rates.
  5. Overlapping claim – Lists tasks that are associated to a claim that overlaps date range.

 

If no tasks fit a category the category will not display.

 

Actions include:

  • “Back” navigates back to step 2.
  • “Reload” reloads the page after changes were made.
  • “Verify and Refresh” verifies the tasks and refreshes the page.
  • “Verify and Next” verifies the tasks and navigates to step 4.
  • “Next” Navigates to step 4 without verifying the tasks.

 

Step 4-Verify Supplies

 

Recorded supplies (billable and non-billable) display and are editable as needed.

 

Step 5-Claim Summary

 

Provides a summary review of the claim. Select “Complete” to finish the verification process.

 

A green checkmark displays when the verification is completed for the pages. Once all checkmarks are present, a selection field presents to the left of the claim.

 

Claim submission options depend on the payment source setup. Options include:

  1. Electronic Submission – Electronic submission to a clearinghouse.
  2. Download – Users download the claims and then upload to the payer portal or clearinghouse. Once the claim/s are downloaded the user must mark the claims as submitted to remove them from the outstanding claim page.
  3. Bulk Print – Provides ability to print multiple claims for mailing.
    1. Select all the desired claims then select “Bulk Print.” The user will have the option to combine into a PDF file, or a Zip file. Either choice will compile the claims for selection under Reports-Completed Reports.
    2. Once printed, update the claim status by Marking Selected as Submitted.

 

 

Claims History

The Claim History page contains the list of a client’s claims. For convenience, a new claim may be added by selecting “New Claim” at the top of the page. The “Expand” icon will expand the list over the claim summary at the top. Select a claim. A summary will then display in the top section of the page with the options to either post payment or adjustment. The information provided in the list includes: Date Range, Status, Net Due, Total Payments, + Adjustments, – Adjustments, Balance Detail/Visits/Supply, Claim Type and Action.

 

Available Action Items depend on the claim status. Most include the ability to:

  • Print – To print a paper copy of the claim.
  • Verify/Edit – To review/update the claim verification process.
  • Update Status – Is the available status which varies depending on the current claim status.
  • Download ANSI – Provides the ability to download the ANSI (text) file for review or submission.
  • Receive Payment – Is available once a claim has been submitted.
  • Delete – Provides the ability to remove the claim.

 

“Post Payment” contains two required fields:

  • Amount – Enter the amount of the payment. The system defaults to the net due, update as needed.
  • Payer – Indicate the payer the received payment is from.
  • Other available fields include: Payment date, Check/RA number the payment is part of, Check Amount and any comments.

 

The claim status will automatically update based on the outstanding balance and includes: paid, partially paid and overpaid.

 

“Post Adjustment” contains three required fields:

  • Amount – Indicate the amount of the adjustment.
  • Adjustment Code – Indicate the adjustment reason.
  • Other Fields – Date, Check/RA Number and amount as well as any applicable comments.

 

~ Claim Quick Reports

To the right of the client information are quick reports associated to the claim selected, allowing the user to view payments and adjustments posted to the claim as well as an activity log showing when the claim was updated and by whom.

 

View Payments/Adjustments:

  • Displays all payments and adjustments associated to the claim with the ability to update or delete if needed.
  • Users may also quickly add a new payment or adjustment from this page.

 

Activity Logs

 

 

Claim Submission History

Claims that are electronically submitted will populate to the Claim Submission History page. This menu allows the ability to review batches of claims, the response files and the claims within the batch. Select the branch, payment source and date range and select “Generate” to narrow return results. The summary line item displays the Batch ID, Payer, Submission Date, Number of claims in the batch as well as an action column from which the user may elect to view the claims, export the file or view the response.

 

Selecting the expand icon (+) next to the batch will display the list of claims included in the batch. Information includes the Client Record number, Client Name, Type of Bill, Claim Date Range, Date Created, Claim Amount and the ability to view the claim.

 

 

~ Response File

The response file will provide a summary at the top and then list the claims within.  Users can “Close” or “Print” upon viewing. It will list the total number of claims submitted along with the number accepted and rejected and provide charges associated with each.

 

 

Help Center

Help/Support & Training/Help Center

 

A great resource that is available 24/7 is our Help Center. A place to get answers to frequently asked questions or watch videos featuring all Axxess products. It can be accessed by going to

 

Or also available at https://www.axxess.com/help/

 

   
  

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