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Billing Center FAQs

 

How do I verify a patients' Medicare Eligibility?

  1. Go to the Create tab
  2. Choose New
  3. Select Patient
  4. COmplete information including the Name, Date of birth, Gender, and Medicare number
  5. Select Verify Medicare Eligibility

 

AgencyCore is connected to the CMS/Medicare database and utilizes the Patient's demographic data which has been input to check and verify the Medicare Eligibility of the specific Patient.

 

How do I view the Medicare Eligibility Report?

  1. Go to the Billing tab
  2. choose Medicare/Medicare HMO
  3. Select Eligibility Report
  4. From here, select your patient in the drop-down menu and the report will generate

 

Must I use AgencyCore to transmit billing requests to Medicare or can I utilize my existing process?

If you are currently downloading your claim files, You may continue to do so. Sending the claims directly from AgencyCore to your clearinghouse or Medicare fiscal intermediary is a lot easier.

 

Can we submit claims to Zirmed, Availity or other clearing houses from Axxess' AgencyCore?

Yes. You can submit electronic claims to any clearinghouse that accepts such claim files.

 

Can I submit claims electronically through Axxess' AgencyCore?

Yes, you can submit claims electronically through AgencyCore. If your insurance provider or clearing house accepts electronic claims, the claim files can be generated from Axxess' AgencyCore.

 

For Medicare patients, claims can be electronically submitted to your Regional Home Health Intermediary like Palmetto, Cigna, NGS or Anthem. Claims can also be submitted to other Part A and Part B clearinghouses.

 

For Private Insurance, you can submit electronically as well. We submit claims to Zirmed, Availity, Emdeon and other clearing houses.

 

How do I enroll to submit claims electronically from Axxess' AgencyCore?

For more information, visit the Submit Electronic Claims tutorial. Please contact our office at (866)795-5590, and one of our representatives will assist you.

 

How soon after signing up with Axxess' AgencyCore will I be able to submit claims electronically?

For most insurance providers, the process is quick. If you are already enrolled with the insurance provider to submit claims electronically, you will be able to do so from within Axxess' AgencyCore almost immediately.

 

If you aren’t already enrolled with your insurance provider to submit claims electronically, for Medicare claims, it normally takes 4-6 weeks for Medicare to receive and process the application. Once this has been done, you will be able to submit claims electronically as well as receive your remittance advice electronically.

 

What insurance can I bill with the software?

You can bill any insurance company. You can find more information in the Insurance / Payor Information tutorial. However, in short to add a new insurance:

  1. Go to the View tab
  2. Select List
  3. Choose Insurance/ Payors
  4. In the top left corner, click the New Insurance button
  5. Fill out the required information
  6. Click Save

 

Can I submit a batch of claims?

You can submit a batch of claims. To do so, complete the RAP/final (EOE) verification process and select Generate all Completed. A list of all verified claims will appear, then select Submit Electronically. You can find more details on submitting claims in the Managed Care / Other Insurances and Medicare / Medicare HMO sections of the AgencyCore tutorials.

 

How do I view a list of outstanding Medicare claims or Pending Claims?

More details found in the Pending Claim tutorial, but in short.

  1. Go to the Billing tab
  2. Choose Medicare/Medicare HMO
  3. Select Pending Claims
  4. Identify and choose your Payor
  5. Select Generate

 

NOTE: The Pending Claims show you claims that have been submitted already. You can update the payment status to remove the claims from the list.

 

How do I find Managed Care / Private insurance claims?

  1. Go to the Billing tab
  2. Choose Managed Care / Other Insurances
  3. Select Pending Claims
  4. Select your payor
  5. Click Generate
  6. This will show you all pending claims for the selected payor

 

How do I regenerate an already submitted claim?

  1. Go to the Billing tab
  2. Select Medicare/Medicare HMO
  3. Select Billing/Claims History
  4. Pull up the patient on the left-hand side of the screen through the search options
  5. Find the claim date that you would like to edit and select Update
  6. Change the Claim Status to Claim Created
  7. You can now go to the Create Claims screen under the Billing tab and go through the verification steps to regenerate the claim

 

Can I cancel Claims from Axxess' AgencyCore?

You can generate claim cancellations from AgencyCore. You can also cancel the claims in the Medicare DDE system other tools provided by your clearinghouse.

 

When do I submit a RAP?

You can submit a RAP after the OASIS SOC or Recertification OASIS and the first billable visit has been completed.

 

Do I need to resubmit a RAP after making changes to the OASIS Assessment?

If the changes made affect the date or the HHRG, then you will need to submit those changes so that they reflect on the RAP.

 

Does AgencyCore utilize HHRG (Home Health Resource Groups) groupers?

Yes, HHRG groupers are used to calculate the prospective payment for the episode.

 

What are HIPPS codes?

HIPPS is a Medicare acronym for Health Insurance Prospective Payment System (HIPPS). A HIPPS code is generated after an OASIS assessment is completed. The HIPPS code determines the prospective payment for the episode.

 

I completed my OASIS assessment but my HHRG or HIPPS code is not showing up. What do I do?

Make sure you have answered M2200 in the OASIS assessment. If no therapy is needed you must place three zeros in the field provided. (ex. 000)

 

If this does not fix the problem, please call Axxess' office and one of our representatives will assist you.

 

What is an HCPCS code?

This acronym stands for Healthcare Common Procedure Coding System.

 

HCPCS codes are used to identify the discipline you are billing for.

 

How do I find out the right HCPCS code for my patient services?

HCPCS codes are determined by your payment intermediary or Insurance Provider.

 

How are HCPCS codes (G Codes) assigned in Axxess' AgencyCore?

For Medicare claims and visits, Axxess' AgencyCore automatically assigns the proper G Code associated with the task/document. For other insurances, you have the option to specify the HCPCS codes required by the insurance company.

 

Do I have to look the G Codes up and assign them for my scheduled visits?

It is not necessary to look up the G Codes.  The G Codes are established based on the type of visit scheduled. (ex: SN Visit - G0154)

 

Does AgencyCore help me bill for DME to Private Pay Insurance?

Yes, AgencyCore includes DME billing in the patient chart, and for RAPs and Final billing submissions.

 

What are "rate modifiers" used by Private Pay Insurance?

Modifiers are claim enhancers used to specify multiple services within the same episode.

 

Can I bill Managed Care Providers through AgencyCore?

Yes, you can bill Managed Care, Medicare, Medicare Replacement plans, HMO'S, Private insurance and Medicaid through AgencyCore.

 

Can I submit OASIS assessments for insurance companies other than Medicare?

Yes.  When you go into OASIS Export from the Create tab, click on the drop-down menu beside Payment Source.  Select which insurance companies you want to submit an OASIS, then click Generate.

 

How do I submit an OASIS assessment for insurance companies?

Go into OASIS Export from the Create tab, click on the drop-down menu beside Payment Source.  Select which insurance companies you want to submit an OASIS, then click Generate.  Click the box beside the OASIS assessments to select the assessments you want to submit.  Click on Generate OASIS file at the bottom.  Save to your computer, then go to your ATT or Verizon dialer and upload.

 

Does AgencyCore check my RAPs and Finals for errors so I am assured that my submissions aren't rejected by Medicare?

The RAP and Final (EOE) both have a verification process that must be completed before processing your claim. This verification process helps to prevent data errors that may cause a claim to reject or go into correction status.

 

How do I know if my RAP and Final claims are accepted or rejected?

  1. Go to the Billing tab
  2. Choose Claim Submission History
  3. Under the Action column on the right, click on the blue hyperlink Get Response
  4. You will see a listing of accepted/rejected claims

 

How do I know which claims batches I have submitted that have a rejected patient's billing in it?

  1. Go to the Billing tab
  2. Choose Claim Submission History
  3. Under the Action column on the right, click on the blue hyperlink Get Response
  4. You will see a listing of accepted/rejected claims

 

How do I know which claims batches submitted to Medicare vendors match my acceptance reports or rejection reports?

  1. Go to the Billing tab
  2. Choose Claim Submission History
  3. Under the Action column on the right, click on the blue hyperlink Get Response
  4. You will see a listing of accepted/rejected claims

 

How do I find the details on the Claims I have submitted?

  1. Go to the Billing tab
  2. Select Medicare/Medicare HMO
  3. Choose Billing Claims History
  4. Find the patient and select the associated claim
  5. Click on Print View to see a UB04 form or HCFA 1500

 

Will we need to cancel our service with IVANS, Ability Networks or other companies that submit claims to Medicare?

No. You may need such a service to submit your OASIS assessments or to maintain access to the Medicare DDE system.

 

How do we track and bill for supplies in AgencyCore?

Supplies can be added to each skilled nurse visit on the supply worksheet, or supplies can be added on your final (EOE) claim. You can learn more in the Supplies tutorial.

 

At the bottom of each progress note, there is an option to document the type and quantity of supplies used. Axxess' AgencyCore automatically transfers that information for billing purposes. Users with Axxess to the billing portion can modify the supplies used accordingly before the claim is created.

 

Does the transmission of EDI transactions rely on a clearinghouse or can transactions be sent directly to payors?

EDI electronic submissions are submitted through a clearinghouse. Axxess' AgencyCore allows you to submit claims directly to any clearinghouse that accepts electronic claims. If the insurance company only accepts paper claims, a UB-04 or HCFA 1500 claim form can be downloaded, printed and mailed directly to the insurance payor.

 

How do I obtain access to the CMS DDE (Direct Data Entry) system? Can Axxess help me with this?

To obtain access to CMS DDE (Direct Data Entry) system, an EDI enrollment must be completed. After your enrollment process is complete, CMS will establish a username and password that is unique for your agency. Axxess will offer any assistance you need to help complete the enrollment process.

 

How do I change the billing rates?

  1. Go to the View tab
  2. Select List
  3. Choose Insurance/ Payors
  4. Select Edit for the insurance payor you would like to make rate adjustments on
  5. Add new/updated rates per discipline and click Save

 

How do I download a RAP/final (EOE) claim file?

  1. Place a check in the box beside all verified claims or select Generate All Completed
  2. Click Download Claim File
  3. Save the file to your designated claim storage location
  4. Upload the file through your designated hyper-terminal or clearing house (ex: GPNET, IVANS, Zirmed)
  5. After you have completed the upload process, please be sure to Mark the Selected Claim as Submitted

 

How do I print a UB-04/HCFA 1500 claim form?

  1. Go to the Billing tab
  2. Select Medicare/Medicare HMO
  3. Choose Billing/ Claims History
  4. Select the episode and type of bill (RAP/final EOE)
  5. Click print view and the UB-04 appears as a PDF document

 

How to remove “Home health service line” from a Claim?

  1. Go to the View tab > List 
    1. Select Insurance/Payors
    2. Locate your Payor > Select Edit 
    3. In the Payor class box, select Edit

Make sure highlighted box is unchecked.

 

 

2. If the claim does not require a RAP or Final (EOE), change the Payor class from Episodic to Per-Visit by following the steps 1-3 on Number 1.

 

 

My OASIS does not have a HIPPS/HHRG code

 

Please check the Patient's listed Demographics

 

 

Created Next Episode

 

Please ensure that the "NEXT Episode" has been created if the client is having challenges with the RECERTIFICATION HIPPS/HHRG calculated amount  not displaying.

 

The Episode Timing Must NOT be "NA"

 

Primary Diagnosis - Please ensure that the Primary DX code is reflective of the ICD-10 rules for services. The ICD-10 codes can be challenging with deeper levels of specificity and exceptions.

 

Therapy Need Must Not be "NA"

 

User Permission

 

Please make sure that their User "Permissions" have not been restricted or modified.

 

NON-Medicare "Payor Set-up"

 

Please make sure they review how that "Payor" is set-up especially for the HMOs that follow Medicare guidelines.