DuxWare Release Note - 01/13/2019
NOTE: For our users who have qualified to receive the Medicare Value Based Incentives for 2019, we have added additional options for Auto-post and our new Batch Payments option for manually posting EOBs.
Below is an example of a Medicare Remittance with MIPS credit adjustment. Amounts in parenthesis are negative credits. When manually inputting a negative credit into your PM, enter it as (e.g. -2.92 and -5.00).
Reason Code Add/Edit:
To access this area, go to: Claims tab>Electronic Remit>Reason Code Setup. Reason Code 144 with group CO should be added as a Reason Code in your Practice Management System. Search for code 144. If not added with Group: CO, then [+Add New]. For the type, select: Value Based Payment (Credit). The action is a credit in your ledger. Example Reason Code add for CO:144.
There will be other reason codes that may need to be added such as: CARC 144,CARC 237, RARC N807.
Excerpt from 2019 MIPS Payments FACT Sheet:
“RAs that include a MIPS payment adjustment will use three code types to communicate information regarding these adjustments. Claim Adjustment Reason Codes (CARCs) are used to communicate when Medicare pays amounts that are different from what was on your original claim submission. Examples:
- CARC 144 “Incentive adjustment, e.g. preferred product/service”
- CARC 237 “Legislated/Regulatory Penalty”
Remittance Advice Remark Codes (RARCs) provide further explanation for an adjustment. Example:
- RARC N807 “Payment adjustment based on the Merit-based Incentive System (MIPS)”
Group Codes show liability for amounts not covered by Medicare. Example:
- CO is used when a contractual agreement between the payer and payee, or a regulatory requirement, resulted in an adjustment.
For more information see the Centers for Medicare & Medicaid Services (CMS)”
Auto-post Setup – Medicare:
To access this area, go to: Claims tab>Electronic Remit>Auto-post Setup.
There is a new option to select a manual adjustment code to show a separate description of the value based adjustment. If you haven’t already done so, you will need to create an additional adjustment code to reflect the Value Based Credit adjustment in your ledger. To access the Manual Payment/Adjustment Codes, go to Support tab>Procedures/Diagnosis>Payment/Adjustment Setup. Below is an example, you can determine what you name this particular adjustment.
Manually Post Bulk EOBs
You will see two new menu items under the Claims tab:
- Batch Posting by Claim #
- Batch Payment History
Claim Payment Posting Batch:
To access this area, go to: Claims tab>Batch Posting by Claim #.
Claim Payment Posting (Batch) allows entry of Bulk EOBs to be input into your Practice Management System for those users who have multiple payments/adjustments to post and have payers that do not send electronic remittances. You will be able to balance your payments/write-offs to the individual claim and then collectively to the payment/adjustment totals that were input from your EOB before you [Finalize] to post payments/adjustments to claims.
Once claims have posted to a batch, the user has the ability to either leave the batch open to continue posting at a later time, or finalize the batch. Finalizing the batch will post the payments and adjustments to the claims in the batch. To view a history of payment batches, go to: Claims tab>Batch Posting Search. If you have posted in previous batches, you will see that either a batch has a status of Finalized or Open. Visit that page for more information.
For Bulk EOBs that you need to post manually - not auto-post, you will use Batch Posting by Claim #. You will see the required fields below. You will select your payer, enter payment (even if zero), and write-off, etc. You will see the required fields, complete them, and select "Start New Batch. If you see Batches that have not been Finalized aka Posted, you will see them under "Continue Incomplete Batch". The batch will not be posted to claims until the Finalize button has been selected.
Once you select [Start New Batch], you will land in Claim Payment Posting. You will see the batch header that has the information that you loaded on the previous screen. You are ready to post to claims. Enter your first claim # and Search.
Input your total payment for the claim and total write-off and start inputting payments and adjustment by service line. If you have multiple adjustments per service line, you can just click the [+] button to the right of the adjustment type to enter as many as needed, add a message to your claim. Once you’re done posting the service lines of your claim and you balance to the payment and write off that you input, select the [Save] button.
Before you begin posting to service lines, select the Configuration button to the left of the of the column headers to select show/hide the available columns to display. Configuration icon:
For multiple adjustments on a single service line, select the [+] icon to add more adjustments.
If all of the claims that you have entered balance to the amounts entered in your batch header, you are ready to finalize/post your batch.
Before you Finalize, you can also view your batch by selecting the [View History] button at the top right of your screen. If selected, you would see a report similar to the Reconciliation Daysheet.
If you select [Finalize], you will be prompted to select Yes or No to mark the batch as Finalized.
You will land in the Batch Posting Search Screen as shown below. You will see your most recent batch at the bottom with a Batch Status of "Finalized". The first column will have a right arrow icon (View Posting Batch) and a left curved arrow (Undo Posting Batch). You will see both Finalized and Open batch statuses.
Batch Posting Search:
To access this area, go to: Claims tab>Batch Posting Search.
Batch Posting Search allows the user to view and manage previously entered Payment Batches. Batches are searchable by Batch ID, Check Number, Check Date, and Batch Status.
- A batch will have either a status of Finalized or Open.
- Finalized: Batch Payments were balanced and posted to claims.
- Open: Batches were left open to continue posting and are waiting to be finalized.
- The first column will have two to three icons depending on the status of the batch.
- Right Arrow Icon: If selected, will allow the user to view the contents of the batch
- Curved Left Arrow Icon: If selected, will Un-post a Finalized Batch (remove payments adjustments previously applied to claims as a result of originally finalizing the selected batch).
- Right Arrow with Vertical Line: If selected, will allow the user to Finalize an Open batch.
To access, go to: Claims>Payment Search. This Query Report has been updated to allow better filtering when searching for Payments.
Patients by Payer
To access this report, go to: Reports>Patient>Patients by Payer.
This report has been updated with new search criteria options and exports to PDF and Excel. User has the ability to drill down to the patient and claim level.
If you have any questions regarding these updates, please do not hesitate to call your Practice Management Support Team Member.