I have some FAQ questions:
1. After they complete OASIS and transfer to pms5 (and get all their
pricer info), are they ready to complete a RAP? Or is there something
else they need?
a. they can then transfer via CL-P4, and once that is done then.
b. The SM-E1 in and out time needs to be entered for the first billable
visit
c. there has to be a POC (not necessariy signed) or a PE-E10 Order
entered to match the first billable visit)
d. Then they can flag and bill it and send it out.
2. Are there any reports that they should run before completing the RAP and
transmitting? The SM-R10 you just added sounds like it would need to be
run at this point to see if there are any patients about to go over budget?
The SM-R10 is like you indicated, so it really is not a good one to run
prior to sending RAP. so the best one is the CL-P4 - preview that is
an excellent pre- Rap Report.
3. They don;t run the PR-R46 for clean claims until they are ready to bill
the final episode, right? So then, they can enter RP in the PE-P4
Abstracts to flag for a RAP, right? Or does it not need to be flagged?
And they would enter today's date (if the RAP is going out today), right?
yes, the RP in PE-P4 is what the cleanest idea is and
then that will put the Y flag later when they need it.
since the PE-P4 auto flag they say code RP and it would
put a Y on each of those. and the item date is the
first billable visit and then the TODAY is the next day
called requested and then the computer does the COMPLETED
date field in the LB-P5.
Medicare as Secondary Payer (MSP)
13. Sometimes when verifying a new patient's information in
the Medicare system under HIQA, a primary insurance will show up. However, the
insurance screen will contain very little information on the insurance company.
(1) In some cases, the Insurer Name will only show Liability,
the address will be the patient's address and nothing else is shown. What action
do you recommend in that situation?
(2) Another example often seen is that the Insurer Name will
show a large insurance company, such as Prudential, with no address. Since large
insurance companies have locations nationwide, how are we to know which location
to send these claims to? Is there a way or place to locate more information on
these insurance situations?
HIQA, HIQH (Helath Insurance Query for Home Health Agencies) while a useful tool, is not a substitute for complete MSP
development. Providers are required to obtain from the beneficiary, complete
information regarding other insurers that may be primary to Medicare. One source
of HIQA records is insurer information submitted on Medicare claims.
Unfortunately, if the submitted information is incomplete, the HIQA record will
be incomplete as well.
To Send a RAP:
1. Flag the RAP in the PE-P4 use auto flag or the abstract code of RP to setup the ones to flag.
2. Run the LB-P1 RAP option for those in the flag list.
3. Run the LB-P2 RAP option it will create a batch with the rpMMDDYY.### for example it would show: rp091200.405
4. Run the LB-P3 as usual.
5. Run the LB-P4 as usual.
6. Run the LB-P5 using the RAP option.
See below each one...
Well, it's me AGAIN!!! Have more questions to verify in my mind what will
happen with the haven bridge process:
1) After the patients keyed in Pe-E1 for a re-admit for one-add will move
over when someone logs in to Haven Bridge in the a.m. and does an import.
This also includes the Pe-P1 screen for recerts, is that correct?!
yes
2) You would then "transfer" those patients to HAVEN.
yes
3) You then run a report "transfer to Haven" showing you the patients that
were transferred over to Haven.
yes
4) You'll then key Oasis all day long on those patients listed. Important
to not LOCK
That might be only at the beginning and not locking might not be
needed since they could forget sometimes since you only have a limited time to lock. So if
the case is clean and the HIPPS is one they are familiar with, they should be ok to lock in Haven. The idea of the not locking was to be able
to see the HIPPS and monies and then make any adjustments to the
oasis. But as the field becomes more familiar with PPS, there is only so many ways to skin a cat, and so its best to Lock before its too
late to lock.
5) Click on HIPPS (view Mode) PMS5 puts this info in and feeds to Pe-P3 pre-authorization
screen
Yes, the view mode will allow them back.
6) Log back into Haven interface, click EXPORT Oasis
Yes, send them back to pms5 those that are already locked.
If they are not locked, after you print the report and run
the process in CL-P4 pms5 will delete the unlocked oasis
ones out, and build a rap file for the locked ones.
7) Transfer to pms5, the info now went back to PMS5
yes,
8) Quit application
yes,
9) Print reports - CL - P4 Process Export/Oasis
yes, this report is for the List of all that came into
pms5. It will first preview them and then also process them.
Its a very important report.
??? What is this report used for????
its used to determine the locked clean oasis that have
been transferred to pms5 and to build a pat_rap table.
Also, do we have a suggestion on what report we can use to track whether all
our patients for a certain time have been filed for RAPs? and what about
60th day billing reports? Would we still utilize the recert report?
yes, and also use the new PR-R46 Episodes option. check it out.
Thanks,
Julie
How would I Setup to start the RAP process and how do we
prepare for the final bill process in terms of setting up the system with proper
codes.
1. Go to the SS-E4 and make sure you have a code that
says QA and another code that says CQ and another that says RP for the RAP.
QA QA Department verified for compliance
CQ Clean QA Claims
RP RAP ready to send
2. You then need to use the PR-R46 Edit report and then the SHORT and then the CLEAN option and that will automatically
enter the CQ code on claims that are ready to process.
3. Or they can do them one by one in PE-P4 abstract by using the code of QA.
now this is for the final episode bills.
If only for the RAP then the code in SS-E4 is RP
RP RAP is clean for transmission
Then using that code the auto flag will work as you
indicated below.
in the below you choose Manual PE-P4 Abstract which means
you would use the QA code not the CQ, the CQ is done using
the PR-R46 method.
For now you enter the episode start date. later it might
default. And the requested date would be that day when she says chart
is clean. The completed date is done in the LB-P5 Section.
So in your example if they enter say from two weeks ago to TODAY,
they can then have all those with dates ready in the field.
and the completed the system enters automatically in LB-P5 like
you said.
Well, HI!!!
Using the abstracts screen Pe-P4 Abstracts: We don't have a code coded CQ
in our systems. Where do I need to add it in PT or SS and how will the
system know to check for CQ (clean claims) which is what you recommended
when you and Alex were here?!! I have down that when using Auto Flag, the
system will look for code CQ which will put a Y in the QA control screen and
also looks at the REQUESTED date of today when the nurse QAs and says chart
clean. System won't flag if orders still outstanding.
Now how to use QA: make sure this is correct. Will be training on this
tomorrow.
PE-P4 Abstracts
Find
MR#
Esc
Select
Enter Staff I.D.
f1 to insert
Key CQ (Clean Report)
Item - Episode start date (????WILL THE SYSTEM ENTER THIS DATE FOR YOU OR DO
WE HAVE TO KEY THE EPISODE START DATE????
> requested date - we will key today's date
> Completed date - Understand that the system will fill in completed date when
> you complete LB-P5, is this correct???
>
> Now when you bill and flag from your email sent last week, I understand that
> when using the TODAY-TODAY method, the system will look at the REQUESTED
> DATE that we keyed as of today. Is this correct. The KEY will be the
> REQUESTED DATE, is this correct!!!!
> Thanks
> Julie
>
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