Meets all PPS billing requirements.

Once patient, treatment, and OASIS assessment data are entered, PPS billing is generated automatically based on the start-of-care date and HIPPS code. No need to wait until month-end closings.

The flexible billing software can accommodate multiple payers, contingent payers, per diem billing, gross and net rates, standard mark-up rates for suppliers, rounded hours for private duty, and spend-downs. Negotiated rates can be applied to individual patients or groups of patients or specific insurance plans.

The system bills for all claims: Medicare, state Medicaid, commercial payers, and patient self-pay. Billing is based on the types of activities performed and negotiated rates at the payer or patient level.

Key financial reports can be generated for every carrier and plan. You can view summary and detailed accounting reports of billing activity, billing registers, deferred claims, service codes for staff and contractors, patient status codes for initial and final claims, and debit and credit adjustments.

PPS billing features include:

• Automatically generates RAPs to improve cash flow.

• Adjustment of case mix levels to account for SCICs

  (significant changes in condition).

• Integrated case mix calculator automatically generates the

  correct episodic rate for billing.

• Automatically bills based on fee for service for Low

  Utilization Payment Adjustment (LUPA) cases.

• Automatically adjusts non-LUPA cases.

Plus, the system gives you these additional billing capabilities:

• Payments and adjustments can be applied from the same

  screen

• Detailed adjustment tracking

• Easy processing of manual and electronic remittances

• Automatic billing of secondary payers

• User-defined billing cycles and frequency — immediate,

  weekly, semi-monthly, or monthly.

• Recording of claim denials

• Monthly spend-downs prorated over weekly bills

• Exports data compatible with most major accounting

  packages — accounts payable, general ledger, and payroll 

• Meets HL7 national transaction standards for data exchange

  in health information systems — helpful in transferring

  patient records from a hospital to home care setting