How to Read the Report
Summary on last page:
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.***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.
The best way to resolve these items is to print this report and then print a couple other reports to compare with it for tracking the issue:
- 01.19, 485 Tracking, to see the status of the patient 485s that have not been mailed or returned
- 13.05, OASIS Tracking, to find unlocked OASIS.
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.
OASIS Not Xported = The OASIS has not been exported.
OASIS no Visit = There is not a first chargeable visit in the Locked+Chg status.
o For Start of Care the visit must be on the admit date.
o For Recert the visit must be on or after the from date of the episode.
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 Orders or 485s or Face to Face. The report will tell you what is holding the claim back.
Common Errors on the PPS Tracking Report:
Unexpected Visit Error = This means that the RAP was created with a visit charge but the first chargeable visit has changed since. Ways to verify this is to go to Billing >PPS Billing > Edit PPS Episode. Pull up the patient and select the episode with the error. Look at the field 1st Visit Date. This is the first chargeable visit that was placed on the RAP. Now go to Visits/Assessments and look for the first chargeable visit.For Start of Care it should be the admit date; for Recert it will be the first chargeable visit on or after the From Date - this is usually where the problem is. Late entry of visit charges will cause this error.
Orders Not Back = Either the 485 or verbal orders are not received from the doctor. You may want to check the chart to see if it has already been received, but maybe not tracked back in Barnestorm. If Orders are not back yet then it will list all orders that are outstanding.
Face to Face error = The Face to Face may not be received yet. Check the chart to make sure you have the order. Once you verify it is in the office signed then go to the patient's 485 screen and select the episode and check the box for Face to Face verified.
POC Chrg Visit = Let's you know if any assessments are not in the Locked+Chg status. Go through your agency's process of locking the assessments when ready. Visit Assessments from POC are Locked+Chg through the Employee Activity > Visit Entry screen or the Employee Activity> Import Visits screen.