|Referral > Demographics||Make sure patient Gender is marked |
|Referral > Demographics||Patient date of birth should NOT be 1/1/1900|
|Referral > Dr + Pharmacy||Make sure Primary Physician is noted and has a valid NPI number |
|Referral > Start||Make sure the County is indicated (CBSA denial is always county) |
|Referral > Payers ||Make sure the HIC# is valid for the payer |
|Codes > Other Basic Codes > Doctors ||Check the NPI for the doctor, and the CA as needed. |
| Correct the Doctor NPI ||This article tells how: |
| Cross Reference NPI to CA ||This article tells how: |
|Codes > Rates > |
|Check the job code used on the visits for the correct HCPCS code |
|Billing > PPS Billing > |
Edit PPS Episodes
| Check all of the information on your RAP: |
- Has it been cancelled or put on hold?
- Is the from date correct?
- Is the admission date correct?
- Does the HIPPS code match?
|To correct a HIPPS code, you follow the instructions in our KB article, OASIS Correction, for correcting a KEY FIELD. http://kb.barnestorm.us/KnowledgebaseArticle50435.aspx |
|OASIS Correction ||The from and thru dates and admission date on the initial RAP are the same. Therefore, the 0023 line item service date must also match. http://kb.barnestorm.us/KnowledgebaseArticle50435.aspx |
|Check the from and thru dates and total cert period days. |
|Therapy need--correct as needed and resubmit. |
|Referral > Payers > |
Extra Billing Info
|If the error code indicates that you need a condition code, include the appropriate condition code and make sure that there are no other codes listed for that claim set date. |
D0 - changes to service dates
D1 - changes in charges
D2 - changes in revenue code/HCPC
D3 - second or subsequent interim PPS bill
D4 - change in grouper input (DRG)
D5 - cancel only to correct a hic or provider number
D6 - cancel only - duplicate payment, outpatient to inpatient overlap, OIG overpayment
D7 - change to make Medicare secondary payer
D8 - change to make Medicare primary payer
D9 - any other changes.
EO- change in patient status note: if you are having trouble getting
E0 change in patient status. Note: if you are having trouble getting E0 to process and it is correctly applied to the claim please contact call center.
If D9 code is missing:
- Look up the patient in Referral and go to Payers > Extra Billing Info.
- Remove any old billing dates and any other condition codes, such as D7.
- Add a new date set to cover the current claims and make sure D9 is the only condition code listed.