SAM Accounts Receivable
Processing
Understanding and Using AR
Features in SAM
Introduction
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This presentation shows how to create invoices
and claims, make adjustments, edit claims, print
and transmit invoices and claims, enter payments
and apply cash, and perform financial and
collection reporting.
AR Topics
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Closing the week
Basic, Period, and PPS Billing
Definition of Invoice and Claim
Viewing Invoices and Claims
Editing Claims
Printing/Transmitting Claims and HIPAA
Adjustments
Payments and Cash Application
Collections and Aging
Reporting
Closing a Period
Closing The Week
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After reviewing the visit (verified), pay item, transportation, service
item, and supply item reports, you can close the week. Items that
are not closed cannot be billed.
To close the week, select the “Close Week” option from the payroll
menu, highlight the office to be closed, and click “Close Week”.
Closing The Week (cont.)
1.
An office must be closed in the front office, then the back office.
2.
Closing the week runs the overtime calculation program.
3.
If overtime is found, a screen report is shown with the option of
printing. You can cancel out if the report shows an entry error, or you
can continue with closing the week.
Basic, Period, and PPS Billing
Invoices and associated claims are
created in one of three ways. The
most basic way of creating invoices in
SAM is the “Billed Weekly, Bi-Weekly,
or Monthly” option which bills “all” or a
selected payer for a standard time
frame. Payers with associated billing
calendars are billed by selecting the
payer and calendar to be billed. All
Medicare billing is done via the PPS
feature that bills Medicare plans of
care.
To create invoices and claims in any of the three modes, click the “Create
Invoices” button. Each invoice takes about 2 seconds to create, and
each claim takes about 1 second to create.
Basic, Period, and PPS Billing
(cont.)
You may create invoices for one client. This feature is handy when
rebilling a specific invoice.
If the invoice creation process is aborted, for instance someone shuts
off the workstation or the server loses power, the invoice in the process
of being created will not be written to the database and none of the
claims for the created invoices will be created. If this happens, create
invoices again so that the remaining invoices and their claims can be
created. Then, using the “Print/Transmit” screen, select the invoices
that were just created and click the the “Create Claim” button. This will
create claims for any of the invoices selected that have a missing claim.
PPS Billing
SAM’s PPS billing uses Medicare plans of care and the associated
OASIS assessments and visits to determine when to create RAP claims,
End of Episode Claims, and to recommend LUPA, SCIC, PEP, and outlier
adjustments. Because of the many features in SAM designed specifically
for PPS, there is a separate presentation dedicated to this. Please refer
to the “SAM and Medicare PPS” PowerPoint presentation on our website
at www.riversoft.net on the “support” page.
Definition of Invoice and Claim
An invoice groups financial transactions so that they can be organized
onto a bill to be printed, transmitted, aged, and have cash applied to
them. Once a financial transaction has been tied to an invoice, it can
only be billed on another invoice using the item or invoice rebill
function. SAM groups financial transactions based on the transaction’s
client, payer, and date.
A claim may also be created to accompany an invoice. A claim is a
billing instrument, a flexible reflection of the invoice, that is printed and
sent, or transmitted to a payer. Once payment is received, the cash
from the payment is applied to the invoice – not the claim.
Claims can be edited whereas invoices must be formally adjusted. The
total amount on the claim can be different than its invoice. And the type
of claim (UB92 or HCFA 1500) associated with an invoice can be
changed at any time.
Definition of Invoice and Claim
(Cont.)
Information on a claim is pulled from information on the invoice as well
as clinical information on the patient. If a claim is wrong, it is
recommended that the source of the information be corrected so that
subsequent claims are created correctly. A locator mapping in the SAM
User Guide explains how each locator is automatically populated by
SAM. If the source information in SAM is updated, and the claims is
deleted and then re-created, the new claim reflect the update.
Financial Transactions and Invoices
The following transactions affect sales and cost in SAM reports like the
sales report and the General Ledger reports…
1. Closed visit, pay item, service item, and supply item
2. Item adjustment
3. Invoice adjustment
Invoices group financial transactions so that they can be organized onto a
bill to be printed, transmitted, aged, and have cash applied to them.
When invoices are created, the Sales (Item) report is unaffected (except
for the bill/unbilled feature). Sales (and cost) are recognized in SAM at
the time an item is closed or an adjustment is accepted, not at the time it
is billed. This makes schedule verification the main payroll and billing
process.
Viewing Invoices and Claims
The “Viewing Invoices and Claims”
option provides viewing access to
invoices and edit access to claims.
Find the invoice using date range,
payer, client, and invoice states. The
columns labeled “R”, “F”, and “T”
show when an invoice is ready
(meaning ready to print or transmit),
finalized (meaning it has been printed
and sent, and transmitted (meaning it
has be exported to an electronic
claims file).
When an invoice or claim is printed to be sent, it is recommended that the
invoice or claim be “finalized”. This allows SAM to track which bills have
and have not been sent.
Viewing Invoices
Once an invoice is selected, the
“Invoice Details” screen is displayed
to show each line item on the invoice.
The print and preview buttons apply to
the invoice being displayed. The
“View Cash Applied” button shows a
pop-up screen detailing and totaling
all cash that has been tied to the
displayed invoice. The Collection Log
button is used to enter collection
comments specific to this invoice –
these comments appear on the aging.
The “Edit Claim” button provides assess to the claim associated with the
invoice. If no claim exists, SAM will ask what type of claim should be
created. In this way you can refresh an invoice’s claim.
Editing Claims (UB92)
Editing Claims (HCFA 1500)
Printing Invoices and Claims
1. Invoices print on plain paper and are designed to work
with standard perforated paper, so that the payee can
send the invoice stub back with their payment.
2. UB92, HCFA 1500, and Massachusetts #9 forms can be
printed on plain paper or red forms
3. As invoices and claims are printed (and finalized), they
are moved from “draft” status to “final” status, so that
which invoices and claims have been processed/sent
can be tracked.
Transmitting Claims and HIPAA
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Transmitting a claim in SAM is just like printing a claim.
On the Print/Transmit screen, you choose either Invoice,
UB92, or HCFA 1500.
The payer and date range is then chosen. If the payer is
not chosen, the “Transmit” button will not be enabled.
Once one or more claims have been selected, the
transmit button will become enabled.
The file created is in the correct format for submission to
the selected payer. You can select the format to be sent
by designating the ECS Style on the Payer.
Adjustments
Once an item is closed, it can only be changed with an adjustment. If
the item adjustment is entered and accepted before its item is invoiced,
the invoice will be created as if the item was correct all along – this is
called a pre-invoice adjustment. If the item is adjusted after it is
invoiced, a new version of the invoice will be created detailing the effect
of the adjustment.
Certain adjustments are not item specific, such as contractual
allowances, write-offs, increases in invoice amounts due to interest
accruals, and others. These are handled in SAM as invoice
adjustments.
All adjustments must be reviewed and accepted before they take effect.
This allows responsibility of the entry and review of adjustments to be
distributed within an organization.
Item Adjustments
Item adjustments behave the same as items in SAM. They appear on all
reports as items and they appear on invoices as items. They are taken
into account on all revenue and cost reports.
There are 4 types of item adjustments because there are 4 types of items
in SAM – visits, pay items, service items, and supply items.
Medicare adjustments for RAP and EOE charges are done by adjusting
the corresponding RAP and EOE service items. Invoice adjustments are
not allowed for PPS based invoices.
Finding Item to Adjust
From the AR menu choose “Make
Adjustments – Items”. The item list
screen will appear allowing you to find
items by date, employee, or
client/payer. Highlight the item to be
adjusted. To change an attribute of
the item, (like pay/bill rates, hours, bill
unit, the employee who did the visit,
or the skill of the visit), choose the
“Adjust” button. To un-bill the item so
that it can be billed again to the same
or a different payer, choose he “Rebill”
button.
If an item has been adjusted or has a pending adjustment, the preadjusted value will show in the sales and cost column. The adjustment
screen will show the adjusted value.
Adjusting a Visit
Edit the “After” amount of the attribute
to be changed. The new amount will
show in red. To change holiday,
overtime, and double-time hours,
choose the “Multiple” button. If you
would like an explanation of the
adjustment to appear on the revised
invoice, enter text into the Invoice
Adjustment field. If you want to
change how overtime was calculated
on a visit, you must use this screen as
SAM automatically calculates
overtime on all visits.
The overtime calculations can only be overridden by using this screen.
Adjusting a Pay Item
Adjusting a Service Item
Adjusting a Medicare PPS RAP or
EOE Service Item
Adjusting a Supply Item
Rebilling an Item
If an item was billed to the wrong
payer, it may be easily billed to the
correct payer using the Rebill feature.
The first step is ensuring that the
client involved is associated with the
correct payer (Schedule Manager,
Administration, Client). Then, instead
of using the “Adjust” button on the
Item List screen, use the “Rebill”
button. The current payer associated
with the item will be displayed as well
as a list of possible payers to rebill the
the item to.
Creating and accepting a rebill adjustment causes a new version of the
existing invoice to be created that shows the rebilled item adjusted to $0.
Rebilling an Item (cont.)
Once the rebill adjustment has been saved, the item’s tie
with its old invoice is broken – it is tossed back into the
billing pool with all other unbilled items. Creating invoices
for the payer/client associated with the item will cause the
rebilled item(s) to appear on a new invoice. Items
incorrectly billed because of an association with the wrong
payer or because of incorrect billing rules/codes can be fixed
easily with the rebill function. The Rebill function is available
at the invoice level as well. The invoice rebill function rebills
each and every item on the invoice via a item rebill
adjustment.
Invoice Adjustments
Invoices adjustments are done when an adjustment should
effect every item on an invoice. Because invoice
adjustments cover all items on an invoice, they are not
represented with items on item reports. For instance, the
Sales (Item) report, a purely item based report, does not
show invoice adjustments. To get a true view of revenue
and cost by payer class that includes contractual
allowances, write-offs, interest accrual, and other invoice
adjustments, use the Summary Sales report on the General
Ledger Reports screen.
There are 5 types of invoice adjustments : Contractual
Allowance, Write-Off, Shift in Payment Responsibility,
Accrued Interest, and Other.
Invoice Adjustments (cont.)
Choosing “Make Adjustments –
Invoice” brings up the “Find Invoice”
screen. Selecting an invoice displays
the “Invoice Detail” screen where you
can either rebill the invoice or choose
to make one of the 5 different invoice
adjustments. The contractual, writeoff, accrued interest, and other types
of adjustments work the same way –
once accepted, a new version of the
invoice (and claim) is created
reflecting the adjustment. The “Shift
Payment Responsibility” is different.
The “after” amount entered causes the existing invoice to be adjusted to
that amount. The difference is shifted to the “shift to” payer, causing a
new invoice to be created when the adjustment is accepted.
Effects of Adjustments
Both item and invoice adjustments affect the amount of
invoices and claims. Because of this, they affect the Invoice
Aging and the Invoice Register reports.
Item adjustments affect the totals on all revenue and cost
reports like the Sales (Item) report and General Ledger
reports. Adjustments do not affect the visit report, pay item
report, supply item report, service item report, and
transportation report as these reports are designed to be
used to aid in closing the week.
Invoice adjustments are shown as separate entries on the
Summary Sales report and the Licensed/Unlicensed Sales
report. The separate entries must be added to item entries to
arrive a true revenue and cost by payer class.
Effects of Adjustments (cont.)
The Licensed and
Unlicensed Summary sales
report is one example of
SAM reporting revenue
and cost of items separate
from the revenue changes
that result from invoice
adjustments. For instance,
to get the true sales figure
for Managed Care visit
sales, the total sales figure
for the Managed Care
visits must be added to the
five Managed Care invoice
adjustment columns.
Effects of Adjustments (cont.)
The Sales (Item) report reflects item adjustments but not invoice
adjustments. Because an invoice adjustment affects the entire invoice, it
is impossible to prorate the effect of the adjustment to each item on the
invoice. The most accurate thing to do is to only reflect invoice
adjustments on reports at the payer class level. All revenue/cost reports
reflect item adjustments. The only reports that reflect invoice adjustments
are…
• GL Summary Sales
•
Adjustment Report
•
GL Licensed/Unlicensed Sales and Cost
•
GL Adjustment Report
The Adjustment Report
The purpose of the
adjustment report is to show
the detail of entered
adjustments. The report
shows the before and after
values for all adjustments
matching the selection
criteria. The Sales (Item)
report may also be used to
report “just adjustments.) If
totals for invoice adjustments
are needed, the GL
Adjustment report or the GL
Summary Sales reports
should be used.
Payments
A payment is a check or remittance
advice that is entered into SAM so that
cash may be “applied” from the
payment to an invoice. To enter a
payment, the payer is first selected
using the “Identify Payer” button. The
the check/remittance number of the
check is entered along with the
amount. To edit a payment to reflect a
change in the payment amount, use
the “Adjust” button. To add or edit
cash applications of the payment, use
the “Apply Cash” button. The
“Payment Office” allows the grouping
of payments per office – this is used
for bank reconciliation.
Applying Cash
There are three ways to
apply cash. After clicking
the “Add” button, you can
type in a 10 character SAM
invoice number to apply
cash one invoice at a time,
or you can choose the
“Invoice List” button and let
SAM apply cash to a group
of invoices. If you need to
look at invoice details to
figure out where the cash
goes, use the “Identify
Invoices” button.
Applying Cash (Cont.)
There are two steps in
applying cash by the “Invoice
List” method. First is to
select a list of invoices to
apply the cash to by entering
a date range and then
selecting the invoices from
the list (rows highlighted in
blue are selected.) Then, on the “Apply
Cash” screen, select the invoices that are
short paid and edit the cash application
amount with a comment as to why the
whole invoice was not paid. Apply cash to
invoices in this way until the Payment’s
unallocated amount is $0.
Payment and Cash Reporting
The Payment report screen not only
generates the payment log, which is a
detailed report of payments entered
into SAM during a period of time. This
screen also can generate the
Payment Cash Application report
which shows the detail of how cash
was applied and from what payments
the cash was applied. The total
payments on the payment log should
equal the cash deposited in your bank
account while the total cash applied
during a period is one of the numbers
that changes the total outstanding AR.
Examples of both reports area on the next slide. If payments in closed
periods have been adjusted, a report of those adjustments is available
on this screen as the third print option.
The Collection Process
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Once invoices are created, they appear on the Invoice Aging report.
There are two ways to relieve the aging of an invoice – apply cash to
it, or adjust it.
If a claim is denied because information on the claim was incorrect,
item adjustments or claim edits may be required and the claim may be
resubmitted/transmitted.
If a claim is denied because some other payer source is responsible, a
“shift payment responsibility” invoice adjustment will be required.
If an invoice/claim is short-paid, an invoice adjustment will be required
to reduce the invoice to the amount paid – this will remove the invoice
from the Invoice Aging report.
During the collection process it is important to log contacts with payers
so that a history of each collection can be maintained. These
histories, or “collection logs” appear on the Invoice Aging report, along
with all other pertinent information regarding the invoice/claim.
The Invoice Aging Report
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The total AR on an Invoice Aging report run for a past “as of” creation date will
differ from the total AR on a later aging by the change in invoiced sales minus
the cash applied to the aging. The Sales (Invoice) report shows these two
numbers and is used to tie agings from one period to another.
The Sales (Item) report will NOT show invoiced or cash application figures as it
is item based. It therefore will NOT tie with the Invoice Aging report. In fact,
none of the item based revenue reports will tie with the aging unless all items
were billed on the week ending day of each item (highly unlikely). What
causes item’s week ending date to vary from its associated invoice dates?
Monthly billing, period billing, rebills, and late time-slips, to name a few.
The aging report is primarily a collections tool, and the dates used to age the
invoices (the creation date or the invoice date) are loosely related to the date of
the item transactions. Items appearing on a sales report may not have been
invoiced, may have been billed on a different date than the item’s week ending
date, or may have been rebilled.
To view how the AR is changing from an item perspective, regardless of the
billing status of the items, use the General Ledger AR – Cash Summary. This
report summarized how the transaction based Account Receivable are
changing, on a weekly based by payer class, for the selected accounting
periods.
The Aging Report (cont.)
Tying Two Invoice Agings With
The Sales (Invoice) Report
Aging grand totals by creation date for as of 12/31/02
Aging grand totals by creation date for as of 01/31/03
12/31/02 AR
Change in Sales for 1/01/03 – 1/31/03 (see next slide)
Cash Applied to Aging 1/01/03 – 1/31/03 (see next slide)
01/31/03 AR
= $192,782.79
+ $210,885.95
- $168,381.33
$235,287.41
Sales (Invoice) Report
The Account Log
The Account Log screen
displays account
information that can be
printed from the screen
in the form of a
statement. Collection
comments should be
entered on this screen to
document the collection
process – entered
comments appear on the
invoice aging.
Statements
Statements are sent to payers and sometimes to clients (private pay) to
provide a statement of their account. A Statement is sent as a normal part
of the collections process, and details what invoices have been sent,
adjusted, and paid.
These may be printed in batch using the
Statement report or one at a time from the
Account Log screen.
Reports
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Sales (Item)
Invoice Register
General Ledger AR Summary
General Ledger
Medicare Episode
Weekly / Monthly Maintenance
Sales (Item) Report
The Sales (Item) report shows all closed transactions in the system and
is selectable by office, client, employee, payer, work unit, skill, affiliation,
referral source, CSR, and service or week ending date range. When
exported to Excel, DBF, or CSV, each transaction contains payer, patient,
and employee demographics so that ad hoc queries like “how many
patients over 70 by MSA code received Therapy visits?” may be
answered.
Invoice Register
The Invoice Register shows invoice details and summarizes by client or
payer and is used to create summarized bills or specialized bills
required by some payers. It is also used to track which invoices have
not moved from draft status (used for bills that have not been sent).
General Ledger AR Summary
This report shows how an office’s total
accounts receivable changes from week
to week, by payer class, during the
selected period range. Total cash applied
is deducted from sales and invoice
adjustments in order to show a weekly
change in AR. This report mirrors how an
office’s General Ledger AR will change
since it is based on SAM financial
transactions, not invoices (like the invoice
aging). This report feeds from the
general ledger data tables, so it is
necessary to run one of the general
ledger reports for the period before
running a AR Summary report.
General Ledger Reporting
The General Ledger reports are a set accounting period based reports
that feed from a set of General Ledger database tables. The tables are
refreshed from the financial transactions tables each time one of the
reports is run during an open period. Once an accounting period is closed
in SAM, the data tables feeding the reports are locked, and will never
change for that period.
GL Sales and Cost
GL Sales and Cost Summary
The Sales and Cost report groups and summarizes Sales and Cost by
office, payer class, transaction type (visit, service, supply, pay item),
employee type, bill unit, and skill/supply/service/pay item type. It is used
to see how cost and revenue should be booked to the General Ledger.
GL Adjustment
GL Adjustment
This report totals the five types of invoice adjustments by payerclass and
week ending date. General Ledger revenue and AR should be adjusted
by the amount of invoice adjustments.
GL Cash
The GL Cash report summarizes the payments entered and cash applied
during a period, grouped by payer class and week ending date. The total
payments relate to how much money has been added to the bank
account. The total cash applications relate to how much of the aging has
been relieved. The totals should balance with the payment log and
payment cash applications report.
GL Summary Sales
The GL Summary Sales report provides a one page report of hours,
visits, cost, and sales broken out by transaction type and payer class.
The Cost and Sales by Discipline (on the next slide) provides separation
by discipline/skill.
GL Discipline Sales
GL Licensed/Unlicensed Sales
Medicare Episode
Medicare Episode Summary
The Medicare Episode report and its summary provides patient, clinical, payment,
PPS coding, episode statistics, and gross margin for all episode ending within a
selected date range. The last page provides episode averages and totals as well
as gross margin. The gross margin is the difference between your actual cost per
visit and supplies and the amount billed to Medicare.
Weekly/ Periodic Reporting
RiverSoft recommends running a set of report periodically so that events
in the system, good or bad, can be reviewed and rectified. Reports in
this category are…
•
OASIS / AR Potential Problem Log
•
Expiring Compliance Rules
•
Unbilled Items
•
Missing Time-slip
•
Client/Payer
•
Filled Visit
•
Recertifications Due
•
Next Supervisory Visit
OASIS / AR Potential Problem Log
The screen and report show different billing and OASIS conditions that
may require attention. Events show both to the screen and can be
printed.
Expiring Compliance Rules
This report shows the doctor
orders, insurance
authorizations,and payer end
dates that expire during a
date range. If you are using
SAM’s compliance checking
feature for tracking payer
authorizations, this report
should be run for a time
period well in advance to
today.
Unbilled Items
Late timeslips that are verified may cause the need to bill older billing
periods. To find transactions that need to be billed, the sales report is
used with the “Unbilled Items” selection.
Missing Time-Slip
A list of confirmed visits during a date range (a missing time-slip report)
can be produced using the multi-function visit report.
Client / Payer
If patient intake is being
performed by a group of people,
it is important that one person
review the new client-payer
relationships that have been
created during the last week.
This quick review can eliminate
billing errors before visits are
even scheduled.
This report also supplies the list
of the skills allowed for each
patient and who is paying for
those skills.
Filled Visit
The filled visit report shows the percentage of visits filled, separating visits
counts by Client and Employee and visit status (like employee cancelled,
client cancelled, unassigned, etc.
Closing An Accounting Period
Immediately after review final GL reports, the period can be closed. This
makes it impossible to add payments, apply cash, or add transactions of
any kind into the period. The general ledger reports will remain static as
well.
Summary
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Effective use of SAM’s AR features should eliminate much
of the manual entry involved with home healthcare and
staffing billing.
The outstanding AR should be reduced as well as the
FTEs required to perform billing and collection functions.
If you have ideas about how SAM’s AR process can be
simplified, email us your suggestion at
helpdesk@riversoft.net.