Billing for Long Term Care

Paper Billing:

• Private Pay
• Patient Liability
• Commercial Insurance
• Managed Care/HMO (electronically, if provider accepts an electronic file)
• Medicare C plans (electronically, if provider accepts an electronic file)

5010 Compliant before 12/31/2011

Hi-Tech Software is now testing the 5010 billing format that will replace the 837 and 835 formats required for Medicaid and Medicare billing. To allow time to submit test claims, the 5010 format will be available well before the 1/1/2012 deadline.

Medicaid Billing:

• Maintain Medicaid Patient Liability worksheet to track those charges and receipts.
• For MaineCare MIHMS billing, maintain Stay Records with MDS Assessment RUG scores.
• Create the Electronic claim file in the 837 billing format.
• Re-bill for prior periods.
• Download Medicaid remittance for automatic posting of receipts (if provided by your State).
• Manage multi-state billing.

Medicare A Prospective Payment System (PPS) Billing:

• Track Medicare payment details in the resident’s Stay Table for each Medicare admission.
• Use the Medicare Stay Start Date and Available Medicare days to generate a required MDS schedule. Use resident’s recorded therapy time to suggest optimum MDS Start Dates to maximize RUG scores to be submitted.
• Automatically collect information to prepare Medicare billing: MDS dates, days and RUG scores.
• Create the 837 electronic billing file to be submitted.
• Download Medicare remittance. Automatically post the receipts.

Medicare B Billing:

• Record therapy Onset Dates and Value Codes in residents’ Medicare B Stay Tables.
• Use the CMS Medicare B Fee schedule for your region.
• Report MTD and YTD therapy fees and charges.
• Create the 837 electronic billing file to be submitted.
• Download Medicare remittance. Automatically post receipts.

Medicare A and B Logs:

• Medicare billing automatically updates the monthly logs.
• Include days, gross revenue, ancillaries, payments, and contractual adjustments.
• Use logs to reconcile Medicare activity for the year with the Medicare PS&R Report.

Medicare C:

• Maintain resident-specific Medicare C profiles.
• Create the required MDS assessment schedule to generate the RUG scores that will be submitted for billing.

1500 Billing for Medicare and Medicaid:

• Record all 1500 charges in the same manner as other charges.
• Access all necessary HCPCs fee schedules.
• Account for necessary co-payments.
• Bill for and record all cash receipts.