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About Pre-Billing Audit report

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Path: Reports>Financial>Pre-Billing Audit 
Path: Claims>Reports>Pre-Billing Audit

With the Pre-Billing Audit report, you can preview and print a summary of patient class, status, acuity, and pay control information for a specified period. This allows for a rapid review of the number of days of a Patient's Acuity vs. their Insurance, Status, and Class. For Benefit Payers, this allows for the comparison of the number of days at various acuity levels to the other parameters prior to Claim Generation. 

On the Define tab, complete the Date Range, Patients, Team, and Sort By sections as appropriate for your agency. Also, specify one of the available report modes: all active patients, specific pay source, specific billing cycle, specific patients, or each team.

For each patient, the report shows the patient class, status, and acuity during the specified period, along with how many days the class, status, or acuity applied to the patient. The results are calculated from Admissions & Status & Payer information and not Claim details. This allows for the report data to be available before the claim generation has been completed. If a patient's class, status, or acuity changed during the reporting period, the report shows all items and the number of days.

The report includes the Audit Report for PPS Claims page. This page is also applicable to PDGM Insurance Codes. This page lists claims that are either missing verified billable visits or have zero charges. This allows for these scenarios to be assessed before Claim generation. If the report does not include any PPS/PDGM insurance codes, the system does not generate this page.

Pay control information includes an analysis of all pay control information for those pointers active in the specified reporting period. The report includes all primary and secondary insurances except for the CSP (Contingent Secondary Payers). This allows for a summary view of payer changes for patients across a date range before claim generation.

  • Primary insurances that have a CSP relationship are followed by the "Sx" in parenthesis (where "x" is the number of CSP pointers).
  • Eligible payers are followed by the (E), and eligible CSP payers are followed by the (EC).
  • Secondary insurances are followed by the relationship for Room & Board (R&B) and Coinsurance (Co).