Bill End of Episode for PPS Payers

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.  

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.

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

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.

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.