Demand billing
Path: Claims > Process > Process a Cycle
Demand billing is the procedure through which beneficiaries can request Medicare payment for services that, according to their HHAs, were not medically reasonable or necessary. Also, demand billing relates to the situation when beneficiaries fail to meet the homebound, intermittent, or noncustodial care requirements, and therefore are not reimbursed if billed.
To set up demand billing in Netsmart Homecare:
- In Administration > Financial > Insurance Codes, define an additional insurance code for PPS to be used for demand billing.
- The bill type for the demand billing is 3x9. Select the appropriate bill type on the Print Variations tab in Administration > Financial > Insurance Codes.
- Attach the new insurance code to the services billing rates and make sure the Non-Covered check box is selected on the Other tab in Administration > Financial > Billing Rates. This ensures that the dollar amounts appear in Form Locator 47.
- Add the condition code '20' to Claims > Process > Annotate Claims.
Associated pages
- About Claims
- Claim types
- Claim statuses
- Claim cycles
- Contingent Secondary Payer (CSP) claims
- Eligible CSP Payers
- CSP claims for primary PPS payers
- CSP claims chain for primary PPS payer
- Recalculation of CSP claims if primary payer is PPS
- Claims corrections
- Claims financial corrections
- Claims demographic corrections
- Void and replacement billing
- Change billing cycle end date
- Process corrections cycles
- Force correction of claims
- Print claims