A. Position Location/Pertinent Information
This position is based out of the Boot Road office in Downingtown, PA. The County Billing Specialist functions under the supervision of the Controller in the Fiscal Department. The County Billing Specialist is responsible for receiving and processing the agency’s county billing.
FLSA/Employment Status: Full-time/Permanent/Non-exempt
Chester County Billing
Core Provider and Residential
- Prior to batching, billing department confirms current liabilities are updated in the County- Links portal, in addition to requesting authorizations for Out Patient services. Updated weekly authorization reports provided by Chester County are entered weekly.
- Claims in statues, approved, transferred and resubmit will be pulled for batching after billing makes corrections
- Claims are scrubbed prior to submission. Any initial rejections are sent to H.S.I billing for correction/adjustment.
- Review FTP site for file transfers daily or as needed for resubmissions.
- Initial claims must be submitted based on the listed guideline for Chester County :
- 60 days from initial date of service
- 30 days for correction resubmission to complete claim process(refer to “OSB-Work Plan” for detail claim resubmission)
- Remittances, payment and denials are posted and corrected daily
- Rejections and Pending visits are reported to H.S.I. weekly for corrections or other actions to rebill with in timely filing limits of 30 days.
Residential Flat File
Monthly Flat File Claim Submission for CCR and Forensic Residential Program
- End of month confirmation of bed assignments sent to program supervisor and director.
- Monthly Room and Board collection- receipts applied to clients encounter
- Billing Department creates and approves rolled/summed visits for each client assigned to a bed for the month.
- Rejections and Pending visits are reported to H.S.I. immediately for corrections or other actions to rebill within 24 hours.
Monthly Manual Claim Submission
Monthly Manual Billing for Liberty House Encounters
- Residential Supervisor provides billing department with a monthly log of daily encounters for Liberty House clients
- Client data and units are summed and transferred to Chester County provided Invoice (excel workbook).
- Completed invoices are submitted to email@example.com for payment
- Rejections are pulled from the FTP site for immediate correction and resubmission.
Monthly Manual Billing for Core Provider- ACM Intakes, Peer Services and IOC Hearings
- Units are reported though non-billable visit notes
- Monthly reports are pulled for each program to transfer client data and units to Chester County provided Invoice (excel work book)
- Completed invoices and IOC back up are submitted to firstname.lastname@example.org for payment.
Confirm and monitor that out sourced billing company post batches and payments weekly
Processing authorizations: Obtain County authorizations for OP clients with no insurance
BCM/RC clients with no insurance/Medicare/Commercial primary.
Assure staff follow the procedures for obtaining Authorizations and or Liabilities
BCM/RC County Authorization Requests:
Oversee and manage all facets of the BCM County Authorization process including but not limited to:
Assure each client has a current liability in EMR system including current income verification.
Assure Client Ext section is up to date on the client’s profile page and a County Auth Form is completed. Staff must email the completed County Auth form to Fiscal at email@example.com
Outpatient County Authorization Requests: Assigned staff needs to make sure that the client has a current (and fully completed and signed) liability in Credible (and current income verification scanned in).
Assigned staff must ensure that the Client Ext section is up to date on the client’s profile page.
Assigned staff then emails the name of the client(s) in need of a County auth to Fiscal at firstname.lastname@example.org. OP services do not require the auth form.
Liability Assessment Process
Ensure Human Services Staff is completing Process Correctly
- Notify consumers if liability will be expiring within two months of their next appointment. At this time, provide consumer with a copy of the “HSI Liability Letter” and review with them what they are to bring in to update liability at next appointment.
- Enter “Credible Note” that this information was provided, and specify if liability update appointment was made. This note does not need to get sent to anyone.
- If liability will expire before next appointment, next appointment should not be scheduled. Follow up appointment can be scheduled at liability update appointment.
- Human Services, Inc. only permits staff members who have attended a county liability training to update liabilities. Staff members who have not attended this training are not permitted to complete liabilities under any circumstance. Staff members are also not permitted to sign off on a liability that they did not complete.
- When consumer brings in liability information
- Check demographics in Credible (name, address, DOB, phone number, SSN, etc.)
- Verify ID is scanned
- Client MUST reside in Chester County
- Scan in financial information to Credible attachments per client
- Complete Chester County’s “ Determination of Maximum Liability Worksheet” in Excel-Current Year’s Worksheet
- Fill in accurate information based on documentation provided by consumer
- Make sure values used are easily identifiable in scanned documentation
- Any calculations made should be written down and scanned in with documentation (ex. Average income calculation)
- Refer to Appendix A. (Non-Residential) or Appendix B. (Residential) to determine “Maximum Monthly Liability” amount, fill this amount in to the worksheet.
- Print liability worksheet and review with consumer before signing and having consumer sign.
- Explain what this value means to the client (monthly amount they are required to pay before the county will pay).
- Sign and date liability and then have consumer sign and date.
- Immediately scan liability into Credible while consumer still present and email signed copy to email@example.com with “Updated Liability” in subject line.
- Enter monthly liability value into “Credible Liability Form”
- Electronically sign and have consumer electronically sign.
- By signing off on the liability, staff members are certifying that they have entered the information accurately, and that all necessary documentation was collected.
- Staff members are not permitted to change liability information once client has signed. If a mistake is noted at a later time, the consumer must come in and redo the liability and sign a corrected version. At this time, the current liability would be “end dated” in Credible for previous day, and a completely new liability (following above procedures) must be obtained.
- If the calculated liability amount is high, and the client is concerned with affording this payment, refer to their assigned case manager or therapist, or supervisor, if necessary.
- It is the assigned case manager or therapist’s responsibility to request a Clinical Abatement for that client. A clinical abatement should not be completed by a non-clinical staff member.
- Collection of Monthly Liability:
- Staff is to collect monthly liability once per month, or it may be split between multiple visits per month.
- Tracking payment collection in Credible through the payment option on the nav bar, by identifying liability payment in the description.
Chester County MHMR LINKS- Linking Information Networks for Knowledge
- Maintain and update the Links Portal