ADL DATA SYSTEMS, INC.

1. ADL DATA SYSTEMS, INC. BILLING ADJUSTMENTS June 7, 2010 11:00 am – 12:00 pm

2. TRANSACTION ADJUSTMENTS Presented by Sara Montoro

4. Adjustments to be covered: • Days Billed • Patient Liability Adjustments • Medicare • Co Insurance Days • Part B Cross-Over Charges

5. DAYS 1. Incorrect Discharge Date. Billing is over 4 days Discharged and Billed Thru : 4/09/08 Correct Discharge Date : 4/06/08

6. Correction Process: * Select Option A – Hand Bill/Void/Transfer * Enter From and Thru dates * Select Paysource to void and click OK * Verify the Net Bill amount and click OK

7. * Review the Ledger * Create a R&B batch in Ancillary to delete the incorrect days displayed as unbilled and enter a second line to capture the correct number of days

8. * Run the Billing process Note: Medicaid Claims that have already been submitted are adjusted in the Re-Billing file

9. 2. Incorrect Admission Date. Billing is short 1 day The resident was admitted on 4/25/08 instead of 4/24/08

10. Correction process: * Void days already billed using Option A * Enter From and Thru Dates * Select Paysource to void and click OK * Verify the Net Bill amount and click OK * Create a R&B charge for missing days in the Ancillary Edit Batch function * Run the Billing process

12. Patient Liability 3. Billed incorrect Liability Amount

13. Correction process: * Select Option K – NAMI/Budget bill adjustment and click OK * Enter the amount billed in the Budget field * Enter the correct amount in the NAMI Bill field and click OK * Review the Ledger * Verify the Expected Income & Budget screen and History fields for the correct liability amounts

15. 4. Billing without Patient Liability Amount

16. I. Correction process: * Select Option K – NAMI/Budget Bill Adjustment * Enter Liability Amount in the BUDGET field * Verify the Net Bill Amount and click OK * Review the Ledgers

17. ** If all accounts need to be corrected then: Use Retro Billing to capture all liability amounts missing from a Billing Cycle

18. II. Retro billing process: * Select the Medicaid tab * Select option 8 - MCAID Retro Billing * Enter the “last date” of the billing, enter the number of days * Select Bill Budgets F option * In Paysources to include remove if Pending Medicaid claims were not included, click OK * Select option 2- Sales Journal and click OK The Sales Journal report displays all missing patient liability amounts

19. * Select option 10 – Post bills to ledgers * Enter Posting Date, Period Ending Date, check Medicaid, Retro and click OK * Review ledgers

20. MEDICARE 5. Billed Incorrect Number of Days. Billed 9 days to Medicare + Co-days instead of Private.

21. Correction process: * Use Option A and enter From and Thru dates * Void Medicare (paysource E) * Transfer Co-Ins from Private (paysource F) to Medicare (paysource E or any other paysource billed as co-ins) *Verify Medicare Paysource screen Co-Ins Code and correct the End Date

23. 6. Billed Medicare instead of Medicaid

24. Correction Process: * Use Option A to Void Medicare – E * Enter from and Thru dates * Select Medicare paysource * Verify that the Net Bill matches the Ledger Amount * Verify the Medicare Paysource screen has the correct End Date * View ledger

26. 7. Billed wrong RUG Scores to Medicare

27. Correction Process: * Use Option A to void Medicare and bill Medicare Co-Days * Verify the Net Bill amount to the Ledger on both screens (Edit Room Allowance Amt.) * Edit MDS Tracking and Bill

29. Co-Insurance 8. Billed Six Co-Days instead of 26 Co-Days

30. Correction Process: * Use Option A to create missing Medicare Co-Days * Enter From and Thru Dates * Select Paysource in Co-Insurance field * Review the Ledger * Correct the claim in Omni Pro

32. 9. Adjustment of billed Co-Days from Insurance to Medicaid

33. Correction process: * Use Option A to void Co-Day Paysource * Enter From and Thru Dates * Select Paysource in Coinsurance field * Verify that the Net Billed matches the Ledger Amount

34. * Review Special Data – Unbilled Days screen * Review the Ledger * Verify the Paysource set up screen and bill Medicaid

35. PART B CROSS OVER CHARGES 10. Billed Part B and Cross Over when resident had no Part B

36. I. Part B correction process: * Use Option A to void Part B Charges * Enter From and Thru Dates * Select T for Part B and click OK * Verify the Net Bill to the Ledger Part B Amount and click OK

37. II. Cross over correction: * Use Option A to void Part B Charges * Enter From and Thru Dates * Select the Paysource Code used for Cross-over and click OK * Verify the Net Bill to the Ledger Cross-Over Amount (Delete any other charges not related to this adjustment. Ex: R&B, etc.) * View the Ledger * Remove the Part B flag from the Paysources screen

39. Reports that help you identify accounts that may need Adjustments: 1. A/R Schedules Report - review file Name PTBALL reports for Unbilled Charges. 2. Ledger for the Month – Patient Sales Report (PTLSUM) for all Unbalanced Accounts displaying an *. 3. Print Registry - with the option NONE selected to include Billed Charges to view any missed Unbilled Charges.

41. The End