Edge Cases & Special Scenarios

Hospitalized Patients#

When a patient is admitted to the hospital:

• Add a "Hospital Stay" note covering the admission dates
• Partial units can be logged for admission and release days only
• The rest of the hospital stay is soft-locked

Rejected Claims#

When a payor fully rejects a billed claim (e.g., missing information, billing error):

1. Remittance uses Adjust Payment (paid = 0, re-bill = full amount) → item converts to re-bill (purple). For RNA visits, use the simple "Re-bill" toggle instead.
2. The issue is resolved offline
3. Billing finds the item via the purple "Re-bills" button and re-submits → day turns blue
4. Remittance confirms payment → day turns green

Payment Corrections (Partial, Overpaid, etc.)#

When payment doesn't match what was billed:

1. Remittance uses Adjust Payment → records paid units + optional re-bill
   • Standard case: original marked paid (corrected units), separate re-bill item created if needed
   • Full rejection (paid = 0): original converts directly to re-bill (purple) — no paid item is created
2. If re-bill created: Billing re-submits the re-bill item → day turns blue
3. Remittance confirms re-bill payment → day turns green

Multiple Visits Per Day#

A patient can have multiple line items on one day:

• Different aides covering different parts of a shift
• Multiple billing codes (e.g., G0156 + T1019)
• An RNA visit alongside a regular visit

Each line item tracks independently through the billing lifecycle.

Missing Prior-Month Timesheets#

A red "# Missed" button appears in the calendar header when there are unlogged days from previous months. Click it to see a list of missed entries grouped by month, then click any entry to navigate directly to that day. There's no time limit — you can log retroactively.

Finding Re-bills#

A purple "# Re-bills" button appears in the calendar header (for the Billing role) when there are items that need to be re-billed — from rejected claims or payment corrections. Click it to see a list of re-bill items grouped by month, then click any entry to navigate directly to that day.

Units Exceeding Schedule#

Hours can flex between days within the same schedule week. The system shows a warning when total logged units exceed the schedule, but still allows the entry.

Patient in Multiple Binders#

Rare but possible — the same patient can appear under different payors. On the /patients page, these patients show with a "— # binders" label indicating they exist in multiple binders.

Billing Before Visit Reports (Unverified Billing)#

Some binders allow billing before visit reports are received. This is configured per binder — payors like VA, DoDD, and BWC have this turned off because corrections on their portals are difficult.

When enabled:

• Billing can mark unlogged days as billed using scheduled units
• Logger sees these as missed visits (red border) and can log actual units when the report arrives
• If actual units differ from billed units, a Billing Error is created for Remittance to resolve
• Remittance sees a "Billing Errors" button in the calendar header and resolves errors via the Adjust Payment form (pre-populated with suggested values)
• The day permanently records the billing error and resolution date as an audit trail

Editing After Billing#

• Logged entries can be edited by Logger or Admin
• Billed entries cannot be directly edited — Billing can undo back to logged, Admin can also undo
• Paid entries cannot be directly edited — Remittance can undo back to billed