The key to successful billing is getting claims out “ timely” and “clean.”  I have listed the basic steps to getting those claims out “timely”, “clean” and to ensure there is a steady flow of income for your agency.  (It is also key to have great communication between data entry staff, clinical staff and billing department, as well as appropriate training.)  Please view the following.

#1 Monitoring Claims To Be Billed:

This can be done daily, weekly, biweekly or monthly based on the Payer.  Medicaid and private pay claims are normally billed monthly, unless the patient is discharged early.  Here is a great report option:

05.23 30/60/90 By Patient Report:  This is a great report to run to track outstanding balances by payer.  This report also includes the “oldest unpaid balance.”  I would suggest starting with any older balances to make sure the billing does not exceed the billing time limit.  This does vary by payer.  Some payers may allow "a year from service date."  Others may only allow a shorter billing time limit, such as 3 months or 6 months from date of service.  It is important to verify any billing time limits, during the admission process, or when determining payer eligibility.

Click here to review and print information regarding this report.

#2 Audits:

Audits are very important to get “clean” claims out the door!  It is normal to have a Clinical staff member do a clinical-audit to verify all assessments have been done, and frequencies match the orders/supplies given, and OASIS information is correct/export/accepted, F2F etc.  Next, is the billing-audit:  verifying all visits are keyed in, all supplies are keyed in and verifying the charges are correct, in addition to any other verification your agency specifies.

Click here for more information on Chart Audits in Barnestorm.

#3 Billing:

Once the audits are done, you are ready for billing.  This is the easiest part:  creating the claims in Barnestorm and then sending them using your normal methods to get those claims to the payer.  Next, is the most important step after the claims leave your door or “mailbox.”

#4  Monitor! Monitor! Monitor!:

Track all claims until the claim is paid.  If the claim gets rejected, you will need to review the error, correct and resend the claim ASAP. 

Suggestions for billing clerk:

1.  Paper tracking:  Make 2 folders labeled (ie.)  “Electronic Claims Pending” and “Paper Claims Pending.”  It is also optional to create a separate folder for each payer.

2.  Print out the transmission sheet for each batch created.  File each transmission sheet in the appropriate folder.

3.  Wait for payments:  Medicaid:  Pull the 835s at each checkwrite.  Once the claim is paid, check off that claim on the transmission list.  Once all claims are paid on the transmission list, you can then file or purge the list.  If claim is rejected or denied, review the denial reason, correct and resend as soon as possible.  

4.  Wait for payments_Other Payers:  For private payers, where the claims are mailed, start tracking those at least 2 weeks after the claim is mailed, and then monitor weekly until the claim is paid. For other payers, who have their own portal, start tracking claims within 2 weeks of transmission.  Once the claim is paid, check off that claim on the transmission list.  Once all claims are paid on the transmission list, you can then file or purge the list.  If claim is rejected or denied, review the denial reason, correct and resend as soon as possible.