ADL DATA SYSTEMS, INC.

1. ADL DATA SYSTEMS, INC. BILLING ADJUSTMENTS September 10, 2009

2. TRANSACTION ADJUSTMENTS Presented by Sara Montoro

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

4. DAYS 1. Incorrect Discharge Date. Discharged and billed thru : 4/09/08 Correct discharge Date: 4/06/08 Billing is over 4 days

5. Correction Process: * Use Option A – Hand Bill/Void/Transfer * Enter From and Thru Dates * Select Paysource and click OK * Verify the Net Bill amount and click OK

6. * Review the Ledger * Create a R&B Ancillary batch to offset the incorrect days displayed as unbilled and enter the correct number of days

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

8. 2. Incorrect Admission Date. Admitted and billed thru: 4/25/08 – 4/30/08 Correct admission date: 4/24/08Billing short 1 day

9. 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 Ancillary charge for missing days * Run billing process

10. * Review the ledger

11. Patient Liability 3. Billed incorrect Liability Amount

12. 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

13. * Review the Ledger * Verify the Expected Income & Budget screen and History fields for the correct liability amounts

14. 4. Billing without Patient Liability Amount

15. 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

16. * Review the ledger ( Retro Billing to capture all liability amounts missing from a Billing Cycle )

17. 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 will displays all missing patient liability amounts

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

19. MEDICARE 5. Billed Medicare due to incorrect cut off date. Billed 9 days to Medicare + Co-days to private Medicare cut off date 4/01/2008

20. Correction process: * Use Option A * 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

21. * Review the ledger

22. 6. Billed Medicare instead of Medicaid

23. 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

24. * View ledger

25. 7. Billed wrong RUG Scores to Medicare

26. Correction Process: * Review Transactions posted * Use Option A to void Medicare and bill Medicare Co-Days * Verify the Net Bill amount to the Ledger on both screens * Edit MDS Tracking and Bill

27. * Review the ledger

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

29. Correction Process: * Use Option A to create missing Medicare Co-Days * Enter From and Thru Dates * Select Paysource in Co-Insurance field and click ok * Enter co-days missing, rate, verify net bill

30. * Review the ledger* Correct the claim in Omni Pro

31. 9. Billed Co-Days to Insurance instead of Medicaid

32. Correction process: * Use Option A to void Co-Day Paysource * Enter From and Thru Dates * Select Paysource (L) in Coinsurance field and click ok * Enter co-ins days, rate and Tab to amount field * Verify that the Net Billed matches the Ledger Amount

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

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

35. 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

36. II. Cross over correction: * Use Option A to void cross over amount billed to private * 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.)

37. * View the Ledger* Remove the Part B flag from the Paysources screen

38. 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 - review file name PTLSUM for all Unbalanced Accounts displaying an *. 3. Print Registry - with the option NONE for the field selected to include Billed Charges to view any missed Unbilled Charges.

39. Thank you. End of Presentation