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How to Read the Report
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When a 485 is printed from POC, it does not generate an episode in tracking, since POC and billing are not connected. On the 485 screen, when you click on the 485 dates, there's a button at the middle top to Create PPS, which can be used to get the episode into tracking. Also, as part of 14.03, is a tab for Search for Missing Episodes, which looks for visits charged to a PPS payer where there is no corresponding episode.***Payers that are not PPS do not generate episodes.***NOTE: The format may display differently based on the options you've selected.Print Monthly ProRatedWhen a 30-day episode covers parts of 2 consecutive months, this report will allocate the episode amount into each month. The allocation can be based on either the number of days in each month, or the number of visits in each month. For example, an episode fromApr 21 - May 20 would have 10 days in Apr and 20 days in May, so allocating based on days would put 1/3 in Apr (10 days of the 30 total) and 2/3 in May. But the episode may have 10 visits between Apr 21 - 30, and then 5 visits May 1 - May 20; allocation based onvisits would be 2/3 in Apr (10 visits of the 15 total) and 1/3 in May. Another option is to use the EOE Dollars. For episodes that have not had the EOE created, the value is one penny. Choosing this option will rate each of those episodes at the HIPPS amount before allocating.Troubleshooting Tips
485 Missing = There's not a matching 485 episode for the billing cert period
485 Not Mailed = 485 has been created but not yet mailed to the physician
485 no OASIS = There has been a 485 identified but the OASIS is not entered or is not completed yet.Check the OASIS screen to see if the patient has the SOC or Recert OASIS entered and locked.
Select A Different OASIS button:
If the OASIS has been created, but still shows as "485 No OASIS" on the report, try manually selecting the correct OASIS. Go to Billing>PPS Billing>Edit PPS Episodes. Pull up the patient and select the episode. Click Select A Different OASIS button. Select the correct OASIS. Exit and try to bill the RAP/NOA.
OASIS Not Xported = The OASIS has not been exported.
OASIS no Visit = There is not a first chargeable visit in the Locked+Chg status.
Dr Not in PECOS = The physician assigned to the 485 is not enrolled in PECOS. Go to Codes > Other Basic Codes and pull up that physician. Click on Validate using NPPES and then Import information to see if that updates the PECOS. You can also try the following link to verify, here.
Visit no RAP = This means the 485, OASIS and first chargeable visit has been entered appropriately but the RAP has not been created yet.
RAP no EOE = This can be a couple of different things.
o The RAP has been created and sent but not paid yet. If the RAP claim is aging but has not been paid yet then you will want to check with the payer to see if there were any issues with the claim.
o The RAP was sent and paid but the EOE has not been generated yet. If the EOE has not been generated yet then the episode will either show up on the EOE billing screen to be sent or it will show up on the EOE error report. The patient must have all documentation returned, the Thru date in the past, and all visits marked as Locked+Chg.
EOE sent, not paid = The EOE has been generated and hopefully sent to the payer. If the claim is aging then check with the payer to see if it is processing or if there were any errors. See the article attached to view the 999 and 277CA files to see if there were any issues with the claim.
EOE paid = This is when the episode has a zero balance and everything for the episode is finished.
On Hold RAP or EOE = Something is holding the RAP or EOE from being generated. Usually from outstanding Orders, 485s, Face to Face; and also if you've manually marked the episode as On Hold. The report will indicate the reason(s) why the claim is being held.