Billing Compliance

Financial Close Date

Admin Lists UsersThe Home Health solution has the ability to indicate a closing date by which all tasks affecting financials must be posted and prohibit any further changes/updates on or before the selected closed date. Closing dates are internal controls that will be permission, date and password, protected by the administrator under the manage company information. The feature is an OPT-IN option and can be disabled/enabled at any time by the administrator or anyone who has been granted permission by the administrator.

  • Administrator is the only role that can assign permissions to add other roles to have the ability for the closed date functionality.
  • The closed date logic will always default to the latest date indicated.
  • The closed date will have hard stops throughout the system and will display an alert for any attempts to update/change tasks on or before the established closed date.

To manage the feature you must first turn it on for each user.  From the main menu choose Admin, select Lists and choose Users. Locate the user you would like to change and on the far right hand side click Edit.

PermissionsOnce inside the employee profile choose the second tab down on the left-hand side Permissions.  Put a check in the box for Manage Closing Date and click Save at the bottom of the page.

Billing User Preferences

Manage Company InformationDoing this will unlock the closing date manager under your agency’s profile. You will now need to go to Admin and choose Manage Company Information. Within the Company Information section, scroll down to Closed Accounting and from here you can manage your company’s hard close date.

Closed Accounting

Pre-claim Review

View Lists PayorsGo to View and select List, then choose Insurance/Payor.

To the right of the Medicare Payor, click Edit Visit Rates. At the top of the screen, you will see a box to Enable Pre-CLaim Review (PCR) Demonstration. Select Yes.

Enable Pre-Claim Review

Admin Lists UsersGo to Admin, select List and choose Users to grant permissions to users with responsibility for viewing and adding Pre-claim information.  Select the desired user, then click Edit under the action column on the right.

PermissionsOn the left-hand side select Permissions, and under Billing, check Manage Pre-Claim Review (PCR) for each user that requires permission to create and edit Pre-Claim Review documentation.

Billing User Permissions

NOTE: Once permission is given, the user must log out and sign back into the system.

Schedule CenterTo see the Pre-claim Review tab, go to the Schedule Center and pull up a patient who has Medicare as a payor and the PCR button will appear next to Authorizations along the top.

Pre-Claim Review

To Add Pre-Claim information, click on the Pre-Claim Review button.  You will then have the ability to attach and upload the Affirmation Decision Letter.

Pre-Claim Review

UTN DetailsNext, you will be able to Add the UTN details.

Lastly, you will be able to quickly view the details of each patient’s Pre-claim Request in one view.

2016 G-Codes

There are four types of nursing skills:

  • Observation and Assessment12122
  • Teaching and Training
  • Hands-On Care
  • Management and Evaluation

Each of these skills has specific guidelines for use in Chapter 7 of the Medicare Benefit Policy Manual for Home Health. The guidelines for nursing skill definition can be found in section 40.1. Please find a brief and incomplete summary of these skills below. For the COMPLETE guidance on Skilled Nursing for Home Health, please go to  (pages 41-55)

Let’s summarize:

These two G-codes and the retirement of G0154 will be effective on institutional claims for home health episodes of care ending on or after January 1, 2016. The official instruction, CR9369 issued to your MAC regarding this change, is available at on the CMS website.

1. Direct skilled nursing services of a registered nurse (RN) in the home health or hospice setting (G0299), service provided by an LPN will be coded as G0300 (Direct skilled nursing of a licensed practical nurse (LPN) in the home health or hospice setting).

  1. Administration of Injections
  2. Tube Feedings
  3. NG and Trach Aspirations
  4. Catheters
  5. IV therapy
  6. Wound care
  7. Ostomy care
  8. Venipunctures are not a skilled service but may be performed if there is another skilled service being performed, and the VP is reasonable and necessary to treat the patient’s unstable condition.

2. Observation and Assessment (G0163)

  1. Usually a skill for 3 weeks or less
  2. Used “where there is a reasonable potential for change in a patient’s condition that requires skilled nursing personnel to identify and evaluate the patient’s need for possible modification of treatment or initiation of additional medical procedures until the patient’s clinical condition and/or treatment regimen has stabilized.”
  3. No longer a skill if patient stabilizes, or if there are no treatment changes within 3 weeks

3. Teaching and Training (G0164)

  1. “Teaching and training activities that require skilled nursing personnel to teach a patient, the patient’s family, or caregivers how to manage the treatment regimen would constitute skilled nursing services.”
  2. “Where it becomes apparent after a reasonable period of time that the patient, family, or caregiver will not or is not able to be trained, then further teaching and training would cease to be reasonable and necessary.”

4. Management and Evaluation of a Non-Skilled Plan of Care (G0162)

  1. This is an RN only skill
  2. “Skilled nursing visits for management and evaluation of the patient’s care plan are reasonable and necessary where underlying conditions or complications require that only a registered nurse can ensure that essential unskilled care is achieving its purpose.”
  3. This is not a long-term skill
  4. Usually, the patient has multiple caregivers in the home and needs the SN to provide guidance or the patient will become exacerbated.
  5. Remember this is for managing a non-skilled care plan: daily weights, Intake and Output, Glucose records, diet management, and medication management after the patient or caregivers have been taught but the patient is stable at the moment
  6. However, if the RN were not there to ensure that these flow sheets were being filled out and if the RN were not there to interpret the data on the flow sheets, the patient would exacerbate.

Obviously, the use of G0162 is RARELY USED, and should not be routinely used on all OASIS. Please also note that G0163 (Observation and Assessment) is also less frequently used, and probably never used on the Recert OASIS. This is why the clinician and/or administrator with the clinician’s input should choose a correct G code at the end of the OASIS.