This is a very detailed article that walks through the steps on how to post Medicare Advantage payments.  The payments must be entered a certain way in order for the PPS tracking system to update the status.  These instructions do not apply to traditional Medicare. 

Enter Payments for Non Medicare PPS Payer 

In order to update the PPS Tracking you must enter the non Medicare PPS payments a certain way.  Otherwise, the PPS Tracking and PPS reports will not be accurate.  This article will walk you thru how to set up the non Medicare PPS codes and Post Paper RA appropriately.  

Set up the ERA Codes

In order for the Update PPSTracking From Payments to work properly you must set up the ERA codes first.  This is a place where you set up the payment and adjustment codes for Medicare and non Medicare PPS payers.  You have two choices, you can use the same RAP payment, EOE payment, and Adjustment codes for all PPS payers (Medicare and non Medicare) or you can use one set of codes for Medicare and another set up codes for non Medicare.   Updating the PPS Tracking will not work if you use a different set of codes for each non Medicare payer.  Example: having three codes set up for each payer (RAP, EOE, Adjustment).

If you do not have any non Medicare PPS payment/adjustments codes set up yet and wish to do so, see article number 50477 on how to set them up.   

To set up which payment and adjustment codes to use go to Accounts Receivable > Post Payments >Set Up ERA Codes.  The picture below is just the example of what the non Medicare codes look like. 

Set up the payment codes in the payer screen

You can set up the payment code in the payer screen so that when you’re ready to post the payments, the RAP and EOE code is already there.  From Codes > Program Related Codes > Payer, enter the program and payer number.  

Enter the RAP payment code in the pay code section.  Enter the adjustment code in the Adj code section.   There’s no need to enter the adjustment code when posting EOE payment.  The Update PPS Tracking part will do that for you. These codes will be the same codes that you have set up in the ERA Codes from above.   

Process of posting payments

This is what the AR Inquiry screen will look like when you first create the RAP.   The date listed beside of the amount is the date the RAP was created.  The Amount is the total amount assigned to the HIPPS code that is associated with the RAP.   The Year/Mo is the billing month.  Each 485 episode can have up to 2 billing periods; the first 30 days is marked with an A and the second 30 days is marked with an B. This is especially helpful when both 30 day periods start in the same month. 

Entering the RAP payment

After you receive the first payment (RAP payment) you can post the amount in Accounts Receivable >Post Paper RA.  Below is an example of how the payment needs to be entered.

• Change the Transaction Date to the bank date
• Enter the RAP amount on the $Amount #1 line  
• The PPS A/B will verify which 30 days you have selected
• Once the payment is entered click on the Save button

After all entries have been entered, run through the right panel and click on View Details, Print as needed, Approve Totals, Post Entries. 

Next, you will run the Update PPS Tracking From Payments tab from Accounts Receivable > Post Payments.  This part will update the tracking to mark the RAP or EOE as paid (ie. RAP paid, 

no EOE).

• Check the box above Step 1. This steps will make sure non Medicare AR is posted correctly.
• Click on the Update PPS Tracking button
• If active, click on the Create A/R Adjustments button 
• Click on the Post to A/R button 

This is what the AR Inquiry screen should look like now.

 

Entering the EOE payment

The next steps would be to create and send the EOE claim when ready. After the EOE payment has been received you can enter it into the Post Paper RA screen.  Below is an example of how it should be entered.   

• Select the correct 30 day period (A or B)
• Change the Transaction Date to the bank date.
• For the $Amount #1, key in the RAP take-back with a negative.
• For the $Amount #2, key in the EOE paid amount using the correct payment code.    
• Click on Save.
• Run through the same steps as with RAP and click on each item in the right panel (posted above), View Details, Print, Approve, Post.  

At this point, the RAP and EOE payment has been entered into the AR Inquiry screen.  Below is an example of what it would look like. As you can see, there’s still a balance left.  Just like Medicare, when you create the EOE claim the HIPPS code is recalculated depending on the data collected throughout the episode.  The EOE payment may be more than or less than the Amount Billed.  

Once you have entered your payments, you can now run the Update PPS Tracking From Payment screen.  This will mark the episode as paid and it will also create any adjustments if needed (do not enter adjustments manually).  Below is an example of what the final AR would look like after completing Update PPS Tracking. 

 

Entering a LUPA Payment

• From the Post Paper R/A screen select the Amount Billed line.
• Key in the EOE amount in $ Amount #1 field, using the Non Medicare EOE Payment code that you have setup.
• Click on Save.
• Run through the same steps as with RAP and click on each item in the right panel (posted above), View Details, Print, Approve, Post.  
• Run Accounts Receivable > Post Payments > Update PPS Tracking From Payments.   
• Note: if a RAP was paid but the payer does not show it as recouped you will check the box above Step 1 from the Update PPS Tracking screen, so that it will create the recoup entry for you. 
• Now the RA will show a Non Medicare EOE Payment with a Medicare LUPA Adj amount.