Set-up for MC Demonstration Project - Pseudo Rate Structure.

I. Set-up: Ancillary Bill Type Table File.

     1.  Type TF ENTER (for table file).
     2.  Type 1 ENTER (to add a table file record).
     3.  Type 8 ENTER (for accounts receivable).
     4.  Type 2 ENTER (for ancillaries bill types).
     5.  Type the Main Key and Secondary Key as shown in the
         screen below and press ENTER.
     6.  Type the balance of the information based on the
         screen below and press ENTER.
     

Ancillary Bill Type Table File - ATF,8,2 (ENTER)

                            ANCILLARIES BILL TABLE
Enter Main Key : PBPSEUDO              Secondary Key: PBPSEUDOR
Description    : MEDICARE PART B  

   Bill     Receive  Send Bill  & Send Bill  Contrct Allow  By C/R Amt
   Type      From      to      to Receivable  Write Off     Written off
  Medicaid   S        PB          N             Y              N
  Medicare   S        NB          N             Y              N
  Private    S        PB          N             Y              N
  VA         S        PB          N             Y              N
  Other      S        PB          N             Y              N

  Bedhold    S        NB          N             Y              N

                                                *PB = Part B
                                               **C  = Co Insurance Provider

  Enter (F) To File (I) To Ignore:  F


II. Set-up: Ancillary Table File.

Use the commands, the ancillaries, and the sample screen below
to set up the ancillary table file records that apply to your facility:
     1.  From any menu screen Type ATF ENTER.
     2.  Type 8 Enter (for accounts receivable).
     3.  Type 1 Enter (for ancillaries).
     4.  Type the Main Key and Secondary Key from the
         table below and press ENTER.
   NOTE: If you get a message saying, the main key already exists you will
         need to go into change mode (CTF) and modify the ancillary record. 
         If you ever billed with this ancillary # call RHS for instructions.  
     5.  Type the balance of the information based on the
         sample screen, and the table below and press ENTER.
     6.  Continue until you enter all applicable ancillaries.

Main Secondary                Revenue           UB92   UB92  V=Visits **
Key  Key       Description    Code    Charge   Part A Part B C=Costed
---- --------- -----------    ------- -------- ------ ------ --------
420  PT        PT Visit       420     1 *NOTE     Y      Y      V
424  PT EVAL   PT Evaluation  424     1 *NOTE     Y      Y      V
430  OT        OT Visit       430     1 *NOTE     Y      Y      V
434  OT EVAL   OT Evaluation  434     1 *NOTE     Y      Y      V
440  ST        ST Visit       440     1 *NOTE     Y      Y      V
444  ST EVAL   ST Evaluation  444     1 *NOTE     Y      Y      V
270  SUPPLIES  Supplies       270     0           Y      Y      C
250  PHARMACY  Pharmacy       250     0           Y      N      C

 *NOTE: The charge for therapies can be either '1' or your actual charge.
**NOTE: Visists/Costed should be left blank for Room and Board (usually 120),
        and Flu Shot ancillaries
Ancillary Table File - ATF, 8, 1 (ENTER)

                     ANCILLARY TABLE CODE MAINTENANCE

Main Key: 420     Secondary Key: PT         Description: PT VISIT

Classification:            RVU:            Bill form (1/2): 1
Anc. Bill Type: PBPSEUDO  Condition:      Procedure/HCPCS:  
Svc. Type Ind.:                                   Modifier:
 Ancil. Basis: V     GL Account No.:     
 T - Treatment       Billing Revenue Code: 420   Ancillary Type:  N
 D-Day V-Visit       Co-Ins.Ancillary#:          (I)-Included in Rate
     Current         Diagnosis code   :          (N)-not in rate  (P)-Pvt
 Charge *Supplier    Bill Bedhold(Y/N):          Doctor:    
 1               Equip Cost (or Non Covered Daily Rate) Current:
      -  Prior  -                                           Prior  : 
rate    dates    Supplier   Service Type     UB92       Writeoff Percent
                            Part A :       Part A : Y   Immediate: 100.0
                            Hicfa  :       Part B : Y   Co-Insur.:   
For Demo Project(Pseudo Chrge)-Based on Visits/Costed Requisition(V/C): V
         (Eg.For PT, OT, ST use 'V', For Pharmacy, Supplies use 'C')
Enter (F) to File (I) to Ignore:  F


III. Set-up: Medicare Demonstration Project Option.
Use the commands, and the screen below to set up the 
Medicare Demonstration Project Option:
     1.  Type UP ENTER (for user parameters).
     2.  Type 11 ENTER (for options).
     3.  Type Y in option 4 as shown below and press ENTER.
User Parameter Option - [NHOP] or UP,11 (ENTER)

  1.   Using 8 Char UserID  21.                     41.               
  2.   Allow for RQ Delete  22.                     42.               
  3.   > 24 Payroll Deduct  23.                     43.            
  4. Y MC Demo Pseudo Chrg  24.                     44.            
  5.                        25.                     45.            
  6.                        26.                     46.            
 


IV. Modify the PT, OT, and Speech history for each resident - as necessary.

For each resident receiving therapy, modify the UB92
billing information screen [UB92INFO] GM, 8, 2, 7. Type the Onset
Date, Date the Plan was Established, and the Date of First Treatment
for all therapies. Also, if available, update the current cummulative number of
treatments as of today. 

This screen needs to be updated periodically as new residents join a
rehab program.




V. Monthly: Posting (entering) Ancillary Charges.
Use the commands, and the screen below to enter your Medicare
ancillaries on a monthly basis:
     1.  Type AR ENTER (for accounts receivable).
     2.  Type 2 ENTER (to post charges).
     3.  Type 2 ENTER (for ancillaries).
         The following screen appears:
Posting Ancillary Charges - [POSTANCL] or AR,2,2 (ENTER)

                              POST ANCILLARY CHARGES
    Add Mode                                                     Verify: Y

 Patient (0 = end): ____________________             Number:   1

 From Date: ________       To Date: ________         Posting Date: _______

 Ancillary: ________  # of Treatments:   Visits: _   Bill Amount: ________
                                                  Auto Bill Co-Insurance :
 Send Bill To:       Receivable From:       Bill The Receivable From
 Bill Amount To Write Off -> Immediately:  Co-Insurance: 

 Diagnosis:   Refer/Order Dr:   Date Last Seen:  by:
                            Attending Dr:     Place of Svc: 
 Related to (Y/N):
         Employment:    Accident  : 
         Emergency :    Payor Code: 
         Diag. Test: 

 L-list, P-post:   Print Option:  A-add, C-change, D-delete:  Number:


    4.   For each Ancillary, type the resident's name (or press PF2).
    5.   At From Date type the first day of the month they received
         treatment.
    6.   At To Date type the last date of the month they received
         treatment.
         Note: If, during the month, a resident left to the hospital and
               returned, or if a resident's bill type changed, you need to
               post seperate transactions reflecting the proper dates.
    7.   At Posting Date type the last day of the month.
    8.   At Ancillary type the ancillary code (or press PF2).
    9.   At Visits type one of the following:
                For therapies type the number of vists,
                For pharmacy and supplies type '1'.
    10.  At Bill Amount type one of the following:
                For therapies leave blank,
                For pharmacy and supplies type the dollar amount.
    11.  Leave all other fields blank and press ENTER to verify.
    12.  Press ENTER again to save the transaction.
    13.  After entering all the charges type '0' at Patient ENTER.
    14.  At List, Post type:
             'L'  to list the charges, or
             'P'  to post the charges.

VI. Monthly: Continue to post your all-inclusive ancillary charges [ALLANCIL].
VII. Monthly: Print UB92 Bills or Create UB92 Diskette.

At this point you are ready to produce Part A (provided you posted
Medicare room and board charges) or Part B UB92 bills.
It is a good idea to produce a paper copy of your first months bills
so that your staff can review the bills before sending them out.

NOTE: The UB92 billing programs are being modified to properly reflect
the nominal $.01 charge for all ancillary charges being billed
under the Pseudo Rate structure. Follow the instructions on the 
Post Ancillary program - THERE IS NO NEED TO FORCE THE $.01 charge.


As always, please feel free to call our client service personnel. 

Thank you.

Sincerely yours,



Client Service