This course will review:

• The calculation of the HHRG & HIPPS code. Review the Episode Exceptions – LUPA, PEP, and Outlier & Therapy.

• Medicare verifications on patients with HIQH screen examples & review adjacent episode calculations. Field by field on claim forms.

• Process of auditing a pre-bill for final claim purposes - both Medicare and Non-Medicare Payors.

• Details of billing for Non-Routine Supplies using list and billing guidelines.

• Electronic Remittance Advices & Codes. Evaluate DDE screens.

This course will review:

• New TIMELY Filing Requirements.

• Face-To-Face Encounter Requirements.

• Therapy – Registered Therapist Visit Requirements.

• Medicare Secondary Payor (MSP) Billing Requirements.

• Step by step of Outlier calculation. Review step by step of Outlier Cap for 2010.

• Billing staff positions and responsibilities that each should have.

• Discuss reports that billing department should prepare each month.

• Illustrate calculations and key issues that should be taken from reports.

• Hands on auditing a pre-bill for final claim purposes – Medicare.

• Hands on calculation of HHRG/HIPPS using a completed OASIS form.

This training would be beneficial to any home health agency Administrator, Director of Nursing, Nursing Supervisor, Coder, OASIS Encoder, Clinician, and any financial and billing staff.

At the conclusion of the seminar, participants will be able to:

• Calculate and evaluate the HHRG, HIPPS Code and Episode Exceptions.

• Effectively verify Medicare Eligibility of patients and complete a RAP and Final Claim form. Calculate Adjacent Episodes.

• Describe the process for effectively auditing a Chart for purposes of identifying pre-bill issues.

• List Non-Routine Supplies and steps in billing them.

• Identify reason codes on electronic Medicare RAs.

• Analyze PPS Changes for 2012.

• Describe the process for effectively billing Medicare Secondary Payor.

• Detail the process of Outliers.

• Identify process for appropriately delegating responsibilities to billing department staff. Discuss reports required for review each month.

• Audit a Chart for purposes of identifying pre-bill issues