Medicaid Billing and AR Manual

How to Run Medicaid Eligibility Reports

Overview: Medicaid eligibility verification involves sending requests to NC Tracks to confirm a patient’s eligibility for a specific month. This is crucial for billing since eligibility can change monthly, impacting patient coverage.

Exclusions: Patients excluded from the report include those without a valid Medicaid payer ID on the Referral, missing gender, discharged before the report's start date, or with a canceled/referral status (unless "Include Referred but Not Admitted" is checked).

Pre-Verification Reports: Before creating the eligibility file, verify patient information using Reports 07.01 and 07.02 in Barnestorm Office under Reports > Audit.

Note: From the Transmit to NC Medicaid screen, always wait for the connection to show as established before clicking on anything and then select the Eligibility bullet.

Creating Medicaid Eligibility Verifications

Go to: Billing > Other > Create Eligibility Verifications.
Eligibility Dates: Default is the current month; adjust as needed. Patients discharged before or admitted after the date range are excluded.
Select Payer: Choose a Medicaid payer from the left panel.
Make Selections: Configure options on the right panel. Only one NPI can be used at a time.

Check "Include all payers with..." to include all relevant payers.
Uncheck “Include all payers with this Receiver Id” and “Include all payers with this Sender Id.”

Optional: Check "Include Referred but Not Admitted" or "Select All PCS" for specific patient groups.
Create File: Click "Create Eligibility File."
Print Report (optional): Print the Patients in Eligibility Batch report.
Repeat: Click anywhere on the screen to return to the main screen and repeat the steps for additional NPIs or payers.

Sending the Eligibility Transmission (File Type 270)

Go to: Billing > HIPAA Transactions > Transmit to NC Medicaid.
Select Files: On the left side, click the “Eligibility” bullet and select the 270 files (marked with a red arrow) to send.
Send Files: Click the "Send" button.
Wait for Response: It may take several hours to receive a response (see next step.)

Receiving Medicaid’s Response (not the eligibility report)

Continue: From Billing > HIPAA Transactions > Transmit to NC Medicaid.
Identify Response File: From the right side, look for a small file (e.g., 301) with a time/date stamp after your transmission.
Receive File: Select the file and click "Receive."
Confirmation: If successful, the 270 file on the left side will show a green checkmark, indicating NC Tracks received it.

Receiving and Printing the Verification Report (File Type271)

Go to: Billing > HIPAA Transactions > Transmit to NC Medicaid.
Receive Verification Report: Select the larger file from the right panel and click "Receive."
Print Report: Go to Billing > Other > Print Eligibility Verifications. Select the file from the right pane and print.

Understanding the Report

Program CAPDA or MCAID with a Status of OK means the patient has direct Medicaid.

Program MQBB with status of MQ means that Medicaid pays the Medicare Part B premium, and that services are not covered by Medicaid. CAP services cannot be billed to Medicaid.

*** NOT NC Medicaid Direct *** means the patient has an active account with the provider listed beside PHP, ex. United HealthCare or Trillium Health Resources.

Example of Medicaid Direct, not PHP/LME

Example of PHP/LME, not Medicaid Direct

** Inactive means that the patient does not have Medicaid for the selected month of the report.

72 Invalid/Missing Subscriber/Insured ID means that the Medicaid HIC# was not found, or the name or birth date does not match the records.

Pvt Insurance will let you know if the patient also has a private insurance policy. Nothing else needs done unless the patient is being billed for skilled services, which may require a denial from the insurance first.

For Medicare Missing D9 - NC Only, this report checks for Medicare conditions requiring special billing codes. If the patient has Medicare but is not homebound, then you have to bill Medicaid and use the D9condition code on the claim to indicate that Medicare is not the primary payer for that service.

Enter Visit Charges

From Barnestorm Office click on Employee Activity > Visit Entry

Use this screen to enter a chargeable/non chargeable visit. This is screen is used when the visit is not added using the clinical Point-of-Care software.

The information entered on this screen is what triggers the charge amount, units, HCPCS codes for the billing claim.

The top portion of this screen allows you to enter visits and the bottom portion allows you to look up past visit entries. You can customize the Data Entry Settings to how you would like to enter the information.

Total allows you to enter a whole number
Time In/Out, Start/End, Odometer allows you to enter a starting and ending point
You also have the choice of N/A

To enter a keyed visit:

*Note: The [Enter] key acts as the [Tab] key to help speed up data entry

Change the date to the visit date.
Enter the employee assigned to the visit by number or search for the name.
Enter the patient chart number or search for the name.
Select a Program/Payer from the drop-down list (this comes from the referral screen > Payers tab).
The employees job code automatically shows up - change this as needed to get the correct HCPCS code for billing.
Enter the visit status.
Enter the visit time, and if needed the travel time, and mileage as needed. NOTE: A visit of only 7 minutes or less will round down to 0 units, and that's not allowed for a chargeable visit.
Click the Save button. The visit will appear at the bottom of the screen.

Medicaid Weekly Visits

This screen is used to enter multiple visits that have the same visit information. To access this screen, (Barnestorm Office) click on Employee Activity > Medicaid Weekly Visits. Here is a brief description of each section:

HOW IS TIME ENTERED (Top, left of screen)

There are several options under this section:

Total Hours; Total Units; Time In/Out– Military; AM/PM – Based on the option you choose, you will be able to enter time in total hours, total units, or key in the time using military or am/pm.

Round Time to nearest 0.05 hr (3 min): The time will be rounded to the next 0.05 hour. For ex: 10:55 will be rounded to 11:00.

Round Time to nearest ¼ hour: The time will be rounded to the next ¼ hour. For Ex: 11:53, will be rounded to 12:00.

Alert when total hours is 8 or more: This will alert you when total hours (for one day) totals 8 or more hours. The number of hours will be highlighted in pink.

1^st Day of Week (0-Sun, 6-Sat): Type 0 (zero) if you want the first day of the week to display as Sunday; Type 1 for Monday; 2 for Tuesday; 3 for Wednesday; 4 for Thursday; 5 for Saturday and 6 for Sunday.

For the Week Beginning: Choose the week you want to key in your visits.

Get Job Code From Employee: If you choose this option, the system will automatically enter the job code that is listed under that employee’s code.

Use 001 for the Job Code: If you choose this option, the system will automatically use this job code (001) for your entries.

Copy Payer Code to Job Code: If you choose this option, the system will automatically use the payer code (you are using) also as the Job Code.

IHA/C and IHA/A Codes: For this field, you can type in your job code for IHAC-Child, and IHA/C Adult.

Recent Visits (Bottom, left section of screen)

From/Thru date– Key in the date range you want to review visits entered. Then click the Refresh button. You can also use the -1 Week and +1 Week buttons to get to the right week.

Show Last: Choose the number of visits you want displayed on the screen.

Employee: If you wish to pull up visits for a particular employee, type in the employee code, then hit Refresh Button. Otherwise leave blank to search all.

Program: If you wish to pull up visits for a particular program, type in the program code, then hit Refresh Button. Otherwise leave blank to search all.

Payer: If you wish to pull up visits for a particular payer, type in the payer code, then hit Refresh Button. Otherwise leave blank to search all.

Job Code: If you wish to pull up visits with a particular job code, type in the job code, then hit Refresh Button. Otherwise leave blank to search all.

Visit Status: If you wish to pull up visits with a particular status, type in the status code, then hit Refresh Button.

Memo Code: The Visit Memo Code can be used to justify why a visit was skipped or not completed as planned. Each agency can setup their own Visit Memo Codes and a description (ie. Holiday). Click Here for instructions on creating Visit Memo Codes.

Adding New Visit (Top, middle of screen)

Search patients for the employee# option: When you check this option, the screen will only show patients that are assigned to that employee (in the Referral/Employee screen). Leave the box unchecked to search all patients.

Entering your data:

Fill in the top section: employee, patient, program, etc
Click the check boxes that match the days for each visit for the week.
(For example: If visits were made on Monday, Wednesday, and Saturday, check those boxes only

Optional Checkboxes:

Allow Multiple Entries Per Week: If you have multiple entries for the week, click this checkbox. Otherwise, you will get this popup if you enter charges for a week that already has existing charges:

Allow Times To Cross Over Midnight: If you have times that cross over midnight, click this checkbox.

Don’t blank out the chart# after Save: If you click this option, the chart number will stay at the top to make additional entries.

Split Visits That Cross Over Midnight Into 2 Separate Visits: If you click this option, the system will separate the visits into 2 separate visits.For example: Time in was Saturday 5 pm and Time Out is 7 am. There will be two visits displayed (after you save your entry):

Click the Save button.

*If you choose to enter visits, on Medicaid Weekly Visits screen, those visits will not show up as "KeyedBy" on the visit/assessment screen.

Medicaid Monthly Visits

From Barnestorm Office click on Employee Activity > Medicaid Monthly Visits. This screen will allow you to key in up to an entire month of entries at the same time - using the same billing information (employee, patient, program/payer, job code, visit status code) for each entry.

How to Enter Charges in Barnestorm

Select how you want to enter your time -- by Total Hours or by Total Units
Enter the Year/Month of visits to be entered
Select days 1-15, 16-End, or 1-End.

There are 3 options for auto-populating the Job Code field to copy the charges into the grid:

Get Job Code from Employee - If selected, the job code will pull from the Employee profile.
Use 001 for the Job Code - If selected, the job code 001 will automatically populate in the Job Code field.
Copy Payer Code to Job Code - If selected, the job code will match the payer code.

Steps up to this point, are a one-time setup, and those settings will be retained the next time you come to the screen. So, from that point forward, you will set the date and then use the following steps to enter in charges.

Start by entering the employee and press the enter key to go to the next field.
Once the client is selected, the Program/Payer field will auto-populate with the primary service that the client has authorizations for. If you are keying charges for a different service, use the dropdown to select the correct service. When the service you want to use is shown in the Program/Payer field, press the Enter key on your keyboard.
The Job Code will automatically generate using the service code depending on how you wanted to grab the job code (employee, job code 001, from payer code). Press the Enter key on your keyboard.
Type in the Visit status code.

Entering Charges

Make sure the data at top of the screen is correct, before keying in your charges in the grid, at bottom of the screen.
Type in your hours or units directly in the grid, at the appropriate date. You can type in the Memo code, if applicable, as well as any Description.
After you key in all the entries, the total Hours (or Units) will appear in the top portion along with the Total $Amount.
Click the Save button.

How to Change the Hours (or Units), as needed

Type the correct information directly in the grid, pressing Enter or Tab after each entry. If date entered in error, type in 0.
After you key in all the entries, the total Hours (or Units) will appear in the top portion along with the Total $Amount.
Click the Save button.

Bill Medicaid Claims

Use this screen to create your Medicaid claims.

The screen is divided into three sections. The following is the order in which you would use it:

2nd Panel: Use this to select the billing date and criteria for payers.

1st Panel: After selecting the patient billing criteria, this panel will show you all patients that were active during the billing dates/payer(s) you selected.

3rd Panel: This area allows you to select the type of charges for the claim. It will gather the charges to print summary or detailed reports before creating the claim. It is also where you will generate the claim.

Select Patients for Claim and Review for Errors

1. Click the Billing button from the Main Menu.
2. Click the All Other Billing item at the top of the screen.
3. In the middle of the screen under Select Patients for Billing, set the From and thru billing dates.
4. You can either chose billing format, or you can specify a certain program/payer. Perform one of these actions:

NC MCO Payers: If you have only one PCSNPI, then all the MCO claims can be created at the same time by selecting payers 840,860,870,880,890 (and if you have children billed as 99509:HA, then add payers 841,861,871,881,891). If you have different NPI numbers for each program, then create separate files for each NPI.

Enter program number (Recommended)
Enter payer number (Recommended)

Select the billing format (you can click the View List button to see the list of formats and select one)

Pull up the patient's name or chart number from the bottom, middle screen to pull individual patients.

5. Click on the Select Patients as Specified Above button. The list of patients will appear in the first panel. This will add any patient that was active during the time frame you have selected - even if they do not have any charges keyed for that time.

6. Dates These Charges Were Keyed: This will default with the From date the same as the billing From date and the Thru date as today. Modify these dates only if you want to capture charges that were keyed during a select time frame. This helps to select late entry charges when a week or month has already been billed. Include Modified Charges = When checked it will include any charges that were added or modified during your Keyed date range. When it is not checked it will only include charges added during the time frame.
7. Click the Prepare Charges for Billing button on the right side of the screen.
8. **Note: If there are any errors, a list of the errors will preview first.
- You may print the list of errors.
- You may view details or summary of the errors.
- You may correct the errors and then return to billing.
- Click the Hide button to hide the errors.
9. To remove patients not ready to be billed (which includes any that came up on the error screen after step 6):
- In the first panel, click on the Chart Number of any patient you do not want to include in billing.
- The chart number will move to the bottom of the second panel.
- If you change your mind, you can click the chart number second panel, and it will move back to the first panel, which is the list of patients for billing.
10. If you remove patients, you will need to click the Prepare Charges for Billing button again.

Review Charges Before Creating Claim
11. Click the View Billing button. A new screen will pop up.
12. Click the View Details button and the details by day and unit and amount will appear.
13. Click the View Summary button and a summary of the total quantity, hours, and amount will appear.
14. Click the Print button to print either the detailed or summary view.
15. Click the Hide button to hide the screen.

Create the Claim
16. Click the Create HIPAA Tx button in the lower right. A new screen will come up with the HIPAA transactions. You can view and/or print the summary or detailed view.
17. Click the Hide button to hide the screen.
18. (Optional if sending paper claims) Click the Print UB04 Form.
19. (Optional if sending paper claims) Click on Print All Claims in This Batch.

Who are you sending the claim to and how to send?

NC Tracks using Barnestorm SFTP: Upload the Claim to NC Tracks (North Carolina ONLY)

NC Tracks uploading claim direct through NC Tracks Portal: Use this step if you are not setup to transmit using SFTP through NC Tracks. Upload the Claim to NC Tracks

NC MCO Portal: If you do not want to use Barnestorms's Change Healthcare service to send claims, you can use each MCO portal to transmit electronic claim files for MCOs: Amerihealth, Carolina Complete, United Healthcare, Wellcare. Barnestorm does not have instructions for uploading the claims on each MCO portal: those instructions are included in the billing guide for the MCO, or you can call the MCO for assistance.

NC MCO Change Healthcare in Barnestorm: Change Healthcare thru Barnestorm for NC Medicaid PCS Managed Care (Change Healthcare, MCO, MCO Claims, Medicaid, Medicaid Managed Care)

Transmit the Claim to Medicaid (Other States)

If you are not transmitting for NC Medicaid, your process will stop at Step 18 (in Barnestorm). You will then log in to the system your state/agency uses to send files to Medicaid, and follow their upload procedures. If you do not know which folder to "browse to," pull up that payer in Barnestorm. Go to Codes>Program Related Codes>Payer Codes. Pull up that payer and select the Electronic Claims Setup button. The file path/Transmit Folder will be listed at the bottom. You will need to find that folder and claim file you created, and upload that file to Medicaid.

Post Charges to AR

Video: Post Charges to AR (youtube.com)

This step is very important for non-PPS payers - it will generate charges to show up in accounts receivable. This is the step that shows the 'Amount Billed' in the AR history. This process is usually ran right after claims have been prepared for a select time frame OR to update the Amount Billed in the case of charges being modified (added/deleted/changed).

Go to Accounts Receivable > Post Charges to A/R item at the top of the screen.

Post Charges to Accounts Receivable

Important Note: If the billing cycle you just finished includes two months, be sure to repeat the instructions for both months.

· First, select the month you want to create charges for:

Month to be Transferred -Select the month and year you need to transfer charges over to the AR, this will be the month you just prepared claims for or the month you need to update in case of changes to charges.

Charges Cutoff Day - You have the option to transfer partial month of charges. This is optional for those agencies who bill every 2 weeks, instead of monthly. Enter the charges Cut-off date. Setting this to a day, prior to the end of the month, allows you to transfer charges for a partial month. If you do not have a cut-off, leave the date as is. The default is the last day of that month to be transferred.

· Optional: Next, we have a few different optional fields you can use, as needed:

Transfer Just One Chart # - Check this box, if you are only transferring the A/R information for one patient. A box will appear to enter that chart number. If the transfer is not specific to a single patient, do not checkthis box to select ALL patients.

Program(s) /Payer(s) -You have the option to enter a specific program and/or payer. If you want to select ALL program and payers then leave these fields blank.

· Next, select which report option you want to print:

You may click the Print Detail to print patient detail or the Print Summary Only to print a summary by program/payer.

Optional: If you are reposting a month because changes were made to charges, then check this box to recalculate the Amount Billed already in the AR.

Remove Previously Posted amounts for .... If this button is selected, the system will remove any previously posted amounts for that month. You will receive a popup confirming that you want to delete those previously posted amounts. Select Yes or No to proceed. NOTE: This popup will only appear after you choose your option on the last step.

· Final Step: The last step is posting the charges in AR. We have step 1 and step 2. You can either run these steps separately or together all at once.

Create and View Charges or Create and Transfer Charges

OPTION A: Selecting the Create and View Charges button. First you will click the Create and View the Charges button. A report of charges to be created will generate. Next you will need to click the Transfer Created Charges button to A/R to transfer those charges. A duplicate report will appear from the Create and View Charges step. We recommend using step 1 and 2 separate if you would like to review the charges before posting them.

OPTION B: Selecting the Create and Transfer Charges button will do it all in one click of the button.

Printing the Report:

Click the printer icon in the upper left to print. Click the X in the upper right to close the print preview screen or hit Close to return to screen.

Report 05.17 - Compare A/R to Charges

This report is used for non-PPS payers. It will compare the visit and supply amounts to the amount in accounts receivable. If there is any difference between the two it will show up on this report. Note: If there are no conflicts, you will receive this message, "All A/R Amount Billed entries agree with the charges." For more information on this report, click this link Report 05.17 Compare A/r to Charges.

Post Electronic Remittance Advice

You will use Accounts Receivable > Post Payments >Post Electronic Payments to post any ERA files.

You will first need to download the ERA files to the appropriate folder.

Post Elec Remit Files (835/ERN):

--> If your agency has multiple payer types you can use the bullet shown at the top of this screen to select which ERA types you need to look for; HH Medicare and PPS, Hospice Medicare and All other payers.
--> If you have multiple folders setup for different payers you will select the folder where your ERA is saved.

A list of 835 or ERNs will appear in the middle of the screen. Select the ERA file you need to post.
Click the Process this 835/ERN File button from the right side of the screen. This button will save ICNs for rebilling and create service line posting details.

The checkbox next to this button only gets used when a change has been made in the software to handle something new and you would need to re-post the RA.

Next, you have the Print Summary and Print Detail buttons that will appear. Print these reports, as needed.
Depending on the payer type you are processing, you may see a Print Denials button. Checking Include All Unpaid Services will print everything, including where you bill more than the pay.
Checking Skip 45 will skip the contract adjustment to help shorten the printed list. Click and print, as needed.

Click the Create ERA Entries button to generate payment entries. A Set A/R Posting Date pop up box will appear. It will default the bank date, only change it as needed, click on OK. Print the report as needed and then click the Close button.
Click the Post to A/R button. A pop-up box will appear once it is finished. Click on OK.
PPS Payers Only - if you are posting PPS payments you will then need to click the Create PPS Adjustments button. These steps will post any adjustments, as well as mark the episode as Paid/Complete. This window will open:

PPS Payers Only - Check the box above Step 1. This will make sure nonMedicare AR is posted correctly.
PPS Payers Only - Click the Step 1 - Update PPS Tracking button. (If no new payments are found, the process stops here. If payments are found, the Step 2 button will activate.) Click Close to exit the preview.
PPS Payers Only - Click the Step 2 - Create A/R Adjustments button. (If nothing is found, the process stops here. This can occur if payer made payment in full.) Click Close to exit the preview.
PPS Payers Only - Click Step 3 - Post to A/R button to complete the posting/mark episode as Paid/Complete. You can now click X to close the window.

Once posting is complete and you want to remove the ERN file from the screen. Click the Archive This 835/ERN File button to remove the ERA file from the list. Check Move All ERN Files to the 835 folder if that is what you want to do.

Correct or Delete AR Posting Error

Use these steps when you have entered a payment/adjustment incorrectly or need to delete an entry altogether.

Barnestorm Office > Accounts Receivable > Inquiry > A/R Inquiry.
Enter a patient chart number or search by name. Once selected, this will bring up the patient’s account history.
Click on reference number (Ref#) for the line you wish to correct. If you do not see the line item you need to correct then click the All Dates button. The Edit an Accounts Receivable Entry window will appear.
TO EDIT: Make necessary corrections and then click on the Save button.
TO DELETE: Click the Delete button. You will receive a prompt asking are you sure you want to delete. Press Yes to delete.
This takes you back to this patient’s A/R Inquiry screen where you can View, Print or Exit the account.

NOTE: Payments can be posted under the Post Payments tab, but you will need to use the Inquiry tab to make any corrections/deletions.

AR Inquiry

The AR Inquiry screen allows you to view the history of a patients account. From the Main Menu in Barnestorm Office click on Accounts Receivable (or Billing) > Inquiry > AR Inquiry.

Enter the patients chart number or search for patient by name. Use the 0-90 Days, 0-365 Days and 0-9999 Days to search for discharged patients.
When you select a patient the From is the Admit date and the Thru date is the current date. You can change the dates to select a specific time frame. After you change the dates click on View to refresh the screen.
You can view all claims or only the unpaid ones.
By default, the Show Newest First is selected. If you want to view the older claims first uncheck this box.

Patient Billing Inquiry

This screen will show you everything you need related to billing. From the Main Menu in Barnestorm Office click on Billing (or Accounts Receivable) > Inquiry > Patient Billing Inquiry. When you select a patient, by name or chart, the patient's demographics appear at the top. This includes the payers, admit date and status (active or discharged).

485s
When you click on the 485s tab a list of episodes will appear. This is handy for patients who have multiple episodes. When you click on an episode the From and Thru dates (from the top/right of screen) will change to that episode. Only the dates for that 485 episode will appear when you click on the Visits and Supplies tab.

OASIS
The OASIS tab will show you all the OASIS Reason for Assessment, HIPPS code, Lock Date and Status.

PPS Compare
This will give you a list of all OASIS entered (on and after 1/1/2008). This gives you a quick look at the details of the PPS episode. The from and thru dates are the episode dates. The first HIPPA code shown is what appeared on the RAP, or the Amount Billed in A/R. The MO826 is the answer on the OASIS for that episode. The TherVx is the actual number of visits done. Tot Vx is the total number of visits completed. The second HIPPX code is the code after the episode was calculated for Therapy, Supplies, LUPA, etc… The $Amount column is the value that goes with the HIPPA codes column. $Expected shows the amount that Barnestorm has calculated should be paid after allowing for Therapy, Supplies, LUPA adjustments. $Diff shows the difference between $Amount and $Expected.The $Paid column only shows an amount when the episode is paid in full. It reflects what was actually paid. The $SupChrg column shows the charge amount for supplies.

A/R
The A/R tab will give you the history of the patient’s billing/accounts receivable transactions. Use the 485 tab to select the episode of A/R you want to view or use the From and Thru dates at the top/right corner to select specific dates.

Visits
Visits will show you all the visits for the selected patient. When you need to troubleshoot billing issues this is a great place to start. You can see the payer, time in, and time out. . Use the 485 tab to select the episode of visits you want to view or use the From and Thru dates at the top/right corner to select specific dates.

Supplies
Supplies will show you all the supplies entered for the selected patient. You can see the quantity and charge amount. Use the 485 tab to select the episode of supplies you want to view or use the From and Thru dates at the top/right corner to select specific dates.

*Note: There are options in the top/right part of the screen to only select specific information.

UPDATE: 3/25/2021 Added new grid to screens in wide screen; added Date Billed on the Amount Billed > Comments line; added a note when charges disagree with amount billed. When only RAP Billed then the date billed does not show up in comments because it is the actual Amount Billed date. If billed multiple times in a month then all billed dates show up in comments. Actual billed date will not show up if the claim has not been created yet.

Don't See Records in A/R Inquiry

1. Select the Patient by entering the chart number or patient’s last name

2. Choose the correct date range for the time period you wish to view; OR

3. You can choose “Only Show Unpaid,” “Show All,” or “Show Newest First.”

4. Then click View

NOTE: If result is "No A/R Found," make sure the appropriate member of staff has performed the Post Amount Billed for the month/patient.

05.17 Compare AR Amount to Actual Charges

This report is used for non-PPS payers. It will compare the visit and supply amounts to the amount in accounts receivable. If there is any difference between the two it will show up on this report. (Note: If there are no conflicts, you will receive this message, "All A/R Amount Billed entries agree with the charges.").

Examples of reasons why there would be a difference: amounts were not posted to the A/R (Amount Billed will not show up in the A/R and the report might show a negative), charges were entered after the billing was done, amount billed was deleted from the a/r, visits were changed from non-charge to charge.

Reports > Accounts Receivable > 05.17 Compare A/R To Charges

How to Run the Report

Year/Month From and Thru = Pulls charges entered for the months selected.

Program(s) = Filter report by entering program number(s). Or leave blank to select all.

How to Read the Report

Year / Mo = Year and month of charges.

Visit+Supply$ = The actual amount that has been entered into the Barnestorm system.

A/R $Billed = The amount that was transferred to AR using Accounts Receivable > Post Charges to A/R. PPS payers will automatically appear once the RAP is created.

A/R Balance = The difference between Visit+Supply$and A/R $Amount.

This report sorts the information by program and has a grand total at the end.

02.35 NC Medicaid Billed/Paid Summary

NOTE: As of February 2015, this report is intended for use with NC Medicaid payers only.

How to Run the Report

From Barnestorm Office click on Reports> Employees > 02.35 NC Medicaid Billed/Paid Summary. This report will show a summary of what’s been billed/paid, including hours for CAP, PCS, PDN and Other. This report also displays adjusted amounts, as well as any unpaid balances. If you would like a detail of each date of service, choose the Print Date By Date Details option (more details below). This report will show a variety of information, based on the filtering option(s) you choose below:

From /Thru = Enter your desired date range for month(s) of service.
Program(s) / Payer(s) / Employee(s) =Filter report by entering program, payer and team numbers. Or leave blank to view all.
UnPaid Charges Only = By checking this box, the report will only display patients with unpaid balances.
Print Date by Date Details = By checking this box, the report will display each date of service and show a breakdown of the $AmtBilled, amount paid, hours, etc. The service date will appear on the outer column of the report. Only chargeable visits will generate on this report.
CAP/PCS/PDN/All = These checkboxes allow the option to choose CAP only, PCS only, or PDN only. You also have the option to select multiple;OR select All by clicking the All box or leave all boxes unchecked to include all in the filtering.
Skilled = Shows you only unpaid skilled services by revenue codes. You have the option to select Therapy Only or Supplies Only, as well.
There are several “Print By”Options.

How to Read the Report

NOTE: The columns seen on your report will be based on the “Print By”option you choose above. The following may or may not appear, based on your “Print By” selection. The totals/calculations, that appear on your report, will be based on the From/Thru period entered above.

Office= Displays the Office Number
Employee = Displays the Employee Last, First Name.
Patient = Displays the Patient Last,First Name.
PCS Hours = Displays the total PCS Hours.
CAP Hours = Displays the total CAP Hours.
Oth Hours = Displays the total Oth Hours. “Other Hours” are hours not related to CAP, PCS or PDN. Note: If you do not specify CAP, PCS or PDN (see above), the report may include any "other hours" as well as charges related to those hours from other payer sources. To ensure that only CAP, PCS, and/or PDN hours calculate on the report, please check those appropriate checkboxes.
Total Hours = Displays total hours,including CAP, PCS and Other.
$AmtBilled = Displays the amount billed for that patient.
$AmtPaid = Displays the amount paid for that patient, even if payment was made after the from and through date.
$AmtAdj = Displays the amount adjusted for that patient, even if adjustment was made after the from and through date.
$Unpaid = Displays the balance due for that patient.

Replacement Claims

Medicaid claims may be replaced directly from Barnestorm. Each Medicaid claim sent for each patient has a unique identifying number, called an ICN. An ICN is a 15-digit number that uniquely identifies one payment of one claim (NC Medicaid).

You need to create a replacement claim when the original claim that was transmitted was incorrect due to missing information or incorrect information (examples: the claim did not include a visit that was added to the system after the claim was sent, or the number of hours billed was incorrect).

IMPORTANT: if the claim rejected and did not pay, then just build a new claim and send it--replacement is not needed when the claim doesn't pay at all.

NOTE: These same steps can also be done for other payers (Medicare, HMOs, BCBS etc); however, the ICN/DCN format may be different dependent on the payer. Some payers may simply call this the "claim number."

Here are the steps to locate/manually enter the ICN/DCN/Claim Number required for all Replacement Claims:

Verify ICN Information

Go to Accounts Receivable > ICN Edit.
Enter the patient's chart number.
If the patient has more than one payer, select the payer.
The ICNs are listed on the right, showing From Date, Through Date, Paid Date, and ICN number. Determine which ICN needs to be replaced based on the dates. Make a note of the from and through dates.
If the dates you need to replace are NOT listed, follow steps below.

If the ICN you need to replace is not there, you can enter it manually using these steps:

Click the Add a New ICN Entry line.
Enter the information from your paper copy of the remittance advice: payment date, from date, through date, and ICN number.
Click the Save button.
Your ICN entry will now appear in the list; make a note of the from and through dates and continue the steps in this process.

Create Replacement Claim

Note: You can create multiple claims in one batch. The entire batch will need to have valid ICN's in the system and no existing filename. Otherwise, a batch will not generate.

Go to Billing > All Other Billing
Enter the from date and through date EXACTLY as they appeared on the claim you wish to replace.
NOTE: The software searches for the matching ICN by matching the chart#, Program, Payer, and date of the first visit. If after making your corrections your “from date” has changed, you may need to change the from date to the first visit date of the claim.
Enter the patient chart number.
Select Prepare Charges For Billing
****Check the box beside Send as Replacement Claims **** THIS STEP IS IMPORTANT****
Create HIPAA Tx.
Go back to Accounts Receivable > ICN Edit. You should see the batch number beside of the ICN number you just created a claim for.
Transmit to Medicaid as normal--the transmission process is exactly the same for a replacement claim as for a regular claim.
Advanced Information (Once you have created the transmission, pull up the claim in your claims folder):

The 837 file has information regarding the UB04 claim:

on the line starting CLM* , after the :: there is a number--

1 = original claim

7 = replacement claim (If there is no “7” then you have not created a replacement claim.)

8= void claim

line after the CLM* has the ICN number

On the claim, itself, the TOB will show 0327 (top right corner of claim).

The 837 file has information regarding the CMS1500 claim:

On the line starting CLM* , after the :: there is a number--

1 = original claim

7 = replacement claim (If there is no “7” then you have not created a replacement claim.)

8= void claim

Only with a replacement claim will the following line appear in the 837 file. This line appears after the "CLM" line. Here is an example of what it will look like:

REF*F8*1234567890 (represents the ICN#)

On the claim, itself, the number 7 (or 8 if it's a void claim) and the ICN# will appear on the line beneath the ICD codes.

Void A Claim

Medicare claims are cancelled directly in DDE.

Medicaid claims, however, may be voided directly from Barnestorm. Each Medicaid claim sent for each patient has a unique identifying number, called an ICN, which is assigned during the claims processing phase.

You will need to void a claim when the original claim that was transmitted was incorrect, and changes to the claim requires full reimbursement to the payer.

Here are the steps to void a Medicaid (or nonPPS payer) claim:

Go to Barnestorm Office> Accounts Receivable > ICN Edit.
Enter the patient's chart number.
If the patient has more than one payer, select the payer.
The ICNs are listed on the right, showing the From Date, Through Date, Paid Date, and ICN number. Determine which ICN needs to be voided based on the dates. (If an ICN entry is not listed, see steps below on how to manually enter the ICN information.)
Click the ICN number for the claim you wish to void.
Change the 7 to an 8 for void.
Make a note of the from and through dates.
Click Save.

If the dates you need to replace are NOT listed, you will need to manually enter the ICN information.

Click the Add a New ICN Entry line. An ICN entry window will open.
You will need to key in the following information directly from the payer remittance advice: Payment date, Charges from date, Charges thru date, and the ICN number.
Change the 7 to an 8 for void
Click the Save button.

Your ICN entry will now appear in the list.

Go to Billing > All Other Billing.
Enter the from date and through date EXACTLY as they appeared on the claim you wish to replace.
Enter the patient chart number.
Click the Prepare Charges for Billing button.
****Check the box beside Send as replacement claims.**** THIS STEP IS IMPORTANT****
Click the Create HIPAA Tx button.
Select the Print UB04/1500 tab, to view the claim. Make sure the TOB (Type of Bill) at the top, right of the claim shows 0328, for void claims. If it does not, one of the steps above was missed. Redo steps to make sure the correct TOB is put on the claim. If you have previously created a void transmission for this same claim, and need to recreate it, go back to the ICN screen, select the date of service, and remove the previously created transmission#, then press Save. **If there is an existing filename, a new batch will not create.
Transmit to Medicaid (or designated payer) as normal--the transmission process is exactly the same to void a claim as it is to send a regular claim.

Advanced Information:

The 837 file has information regarding the claim:

On the line starting CLM* , after the :: there is a number--

1 =original claim

7 =replacement claim

8= void claim (If the number 8 does not show, you did not create a void claim.)

line after the CLM* has the ICN number.

When to Create a Replacement or Void Claim

Here are some scenarios on when to send a replacement or void claim to Medicaid. See related articles on: Replacement Claims / Recoupment and Void a Claim.

*Note: If multiple payments were made for the month, make sure you use the correct ICN when creating a replacement or void. When multiple payments are made only the most recent ICN will show up in the ICN Edit screen.

To send back a payment on supplies / visits (when multiple services paid on one claim):

Change the quantity or delete the supply / visit charge
If the visit/supply that was deleted is the same date as the From date of the ICN Edit screen, and the only charge on that date:
Change the From date in the ICN Edit screen to the first chargeable date on that claim. You'll have to delete the current ICN entry and then add a new one back with the same payment date, thru date and ICN number.
Create and send a Replacement Claim

To send back a payment on a supply / visit (when it is the only service paid on one claim):

Leave the supply or visit in the system
Change the ICN entry to a Void
Send the Voided Claim
After payment has been taken back, you can either delete or mark item/visit nonchargeable.

If a partial payment was made on a visit / supply then complete the steps on creating a Replacement Claim.

If a visit / supply did not receive any payment: (case management and aide)

By doing this process you change the date on the visit/supply date keyed and when you resend the claim only those changes will appear on the claim.

Pull up the supply or visit from the entry screen
Change the supply quantity or visit time and click on save
Pull the supply or visit back up and change back to correct information
Follow steps on creating a Replacement Claim
When you rebill the claim use the Dates These Charges Were Keyed for the date you made the changes

If a full payment needs sent back due to changing all visits / supplies to a different payer:

Create the Voided Claim
You can change the payer code on the visits / supplies after the claim is created or you can wait until the claim is processed. If you change the visits before the claim is processed and it gets denied, then you can always go back and change the payer code to what is used to be and recreate the void claim, as needed.

Write-Off An Outstanding Balance, Per Chart

From Main Menu, go to Accounts Receivable > Post Payments > Post Paper Remittances.
Enter chart number for the patient, or key in first 3 letters of last name and select the patient.
(If the patient has been discharged, choose the proper bullet that indicates number of days discharged.)
The patient’s A/R history will appear on the screen. Click on the line that holds the balance to be written off.
A mini screen will appear (see below) – “Add/Edit An Accounts Receivable Posting Entry” – Verify Transaction Date.
At Amount # 1, you will enter the amount to be written off.
At Code # 1, you will enter the pay/adj code that indicates a write-off.
There is a Comments section where you can enter a brief note.
Select Save.
Select View Detail (To verify your posting is correct.).
Select View Totals (To verify total is correct).
Select Approve Totals.
Select Post Entries (A box will appear "Posting is complete.").
Select Refresh A/R Detail to view your changes.

To Get a Total$ of Your Write-offs, Here Are a Few Report Options:

05.07 Pay/Adj Code Totals by Quarter - This report does not include the option to filter by pay/adj code.

05.08 Selected Detail - This report does include the option to filter by pay/adj code. If you are just printing details of write-offs, enter your agency code(s) for write-off in the pay/adj code field.

05.11 Totals By Program/Pay/Adj Code - This report includes the option to filter by pay/adj code. If you are just printing details of write-offs, enter your agency code(s) for write-off in the pay/adj field.

To Locate Your Payment/Adjustment Codes, Go To:

Barnestorm Office > Accounts Receivable > Pay/Adj Codes

The codes will be listed on bottom, right of the screen. Select the program number to view the pay/adj codes your agency has set up. Use the Print buttons to view the reports.

If you need to set up a new pay/adj code, click here for the article link.

Medicaid Billing and AR Manual

Please provide this link to your billing staff.

We recommend saving the link to your favorites list in your web browser

versus printing, as changes are made often.

Table of Contents

Eligibility

Billing

Using Transmit to NC Medicaid (barnestorm.biz)

Accounts Receivable

Other

Eligibility Verifications for Medicaid