In this document, you will find instructions for billing end of episode (EOE) claims for Medicare PPS, and any plans that follow Medicare billing guidelines. These non-Medicare PPS payers may include payers such as Humana Gold Choice and Tricare.  

For updates related to 2021 RAPs, we recommend running the process from Reports > Billing > 14.03 > 2021 RAPs before completing EOE claims.  This will match up the episodes with Oasis DocID @@ to update the tracking with exported OASIS and returned 485.  

• Click the Billing button from the Main Menu > PPS Billing > End of Episode Claims.
• Select from the options at the top, middle as needed

Print 485/VO Not Back: Checking this box will exclude episodes that have errors.  Unchecking will include episodes.  This option will look for orders/485s not returned, starting two weeks before the admit date and on.

Audit Must Be Complete: This will select episodes that have a PPS Episode Chart Audit completed (printed).  Click here for instructions on that process.

Completed Episodes Only: When checked it will select episodes that have a thru date on or before the Select Episodes for Billing Thru date that is selected.  When not checked it will still only select those episodes that have an episode Thru Date on or before the Select Episodes for Billing Thru date, but will also check for errors all episodes that are in a PPS status 4 = RAP no EOE.

RCD UTN Mandatory Starting: For customers who require UTN, this will require episodes to have a UTN before creating a claim. https://www.barnestorm.biz/kbart?id=51469

• Select the payer you want to bill from the list in the middle of the screen. You will see a status bar working through the process of updating the PPS Tracking.

**Note: If there are any errors, a list of the errors will appear.

• (Optional) Print the list of errors and fix any that can be fixed. 
• Click the Close button to hide the errors.
• The number that shows up next to the payer name will depend if you have Completed Episodes Only checked or not.

Checked will show the number of episodes ready for billing as well as the episodes on the error list.

Not Checked will show the number of episodes that are at least in the PPS Status 4 = RAP no EOE.

• The EOE episodes ready to bill for the selected payer will appear to the left.
• To remove EOEs that you do not want to bill:

In the upper left, click on the Chart Number of any EOE you do not want to include in billing.

The chart number will move to the bottom center of the screen, under Episodes Removed From the Selected List.

If you change your mind, you can click the chart number in the bottom center section, and it will move back to the upper left, which is the list of episodes for billing.

• Make sure that the list on the left shows the EOE episodes you wish to bill.
• Click the Create Billing button on the right. Wait while the software creates the EOE claims.
• When the EOE batch is complete, a new file has been created.
• Click the Print Details button to print the list of episodes.  A new screen will come up with a print preview.  The serial number (transmission) will appear in the header.  Click on the printer icon to print then click on Close.
• Click the Hide button to go back to the billing screen. Note that the right side of the screen indicates that the created EOE claims is complete.
• If the claims need to be printed:  Click the Print UB04/1500 button.
• The claim file you just created will automatically be selected.
• Click the Print All Claims or selected claim.
• Click the icon with the printer in the upper left corner to print the claims.
• Click the X in the upper right corner to close the printer page.