Top 5 home care billing questions

by | Jul 26, 2023 | Home Care, News, Product Questions

You need to complete a home care billing or home care operations task. But you hit a roadblock. The Pavillio Support team is here to help – including arming you the right information to keep you moving ahead. Here are five of the most frequently asked home care billing questions and answers from the Pavillio team to help you streamline your home care operations.

Home care billing question #1: A record is in the failed card with the reason “UoM does not exist.” Why?

This means that the service code on the record is no longer on the service agreement (SA) and the change was made after the record was entered. To correct this, make sure autopriority is set to NO on the service agreement. Then, in the failed card>Actions>Change SA, the user will select the correct service code that matches with what’s available on the SA. The record will revalidate and move to Ready for billing.  

Home care billing question #2: A record is in failed with reason “Claim already exists for specified date.” Why?

This occurs when two records are entered for the same date of service/client/service code and one record has been sent to the payor before the other is entered into the system. When this happens, if the second record is sent to the payor, the claim will be denied as a duplicate. So this record fails in the system. Once the remit comes back for the sent claim, the user can move this record to the workbench and, if payment was made on the claim, hit replace. This will send the claim back through the system validations and it will combine with the record in the failed card. This will then go to the ready card as one claim to be sent to the payor. 

Home care billing question #3: Failed vs Rejected vs Denied. Do those mean different things?

When a visit is finalized, the record goes through a series of system validations to be sure that it’s ready for billing. The SA is correct, units are available, the client is eligible, etc. There are MANY (upwards of 45) checks that Pavillio does for each record. If the record goes into the failed card, the reason is displayed for you so you know what needs to be corrected before the record is ready for billing. 

So what is the difference with Rejected? When the claim is sent to the payor, there are certain things that must be correct on the claim itself in order for the payor to accept the claim. These are things like valid diagnosis code, correct formatting, UMPI number if required for the service, etc. If the claim is rejected, you’ll find these in the Claims card in Pavillio. If the reject reason is available from the payor, it will be displayed in Pavillio for you to address. If you’re not sure why the claim was rejected, our support team is happy to assist.  

And what about Denied? Once the claim is sent out and accepted by the payor, the payor will either make payment on the claim or will deny it.  If the claim is denied by the payor, the reason that is sent back is available for you in Pavillio. These are reasons that come from the payor directly. If there are questions around denial reasons, the payor may need to be contacted directly to resolve them.  

Home care billing question #4: How do I manage users when Pavillio says “email address already exists?”

When adding a new user into Pavillio, the email address for each user must be unique for each user/role. If the user is in the system with the same email address and a different role (for example, a client in one agency and an employee in another) the user will need to have 2 separate email addresses, one for each role.

Or if a user was created with a fake email address in one agency and was in a different agency with the real email address, this error message will occur. In these instances, please contact support to assist in resolving these issues. It’s very important to confirm that the email address is correct when creating the user to avoid potential issues.  

Home care billing question #5: What do I do with parked transportation records?

When entering in transportation – autopriority must be set to YES on the client service agreement.

If this is set to NO, the record will come into the failed card in Parked Status. These records will need to be deleted and reentered to resolve this. There is a system change planned to address this issue. 

By familiarizing yourself with the Pavillio framework and understanding commonly shared questions and answers to resolve, you can navigate and solve home care billing and home care operations questions quickly and efficiently.

Interested in learning more? Check out our webinars to get tips on how to best maximize Pavillio for optimal results.

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