Troubleshooting $0 Claim Amounts

A claim is generated but appears with a $0 total, which may be due to missing billing data or setup issues.

For PDGM (Insurance Billing):

1. Check if a HIPPS Code was generated on the Plan of Care or OASIS.
   
   
   • If no HIPPS code is showing:
     
     
     • Check the Primary Diagnosis field and ensure a Clinical Group is assigned.
       
       
2. If HIPPS exists but the claim is still $0:
   
   
   • Resave the Plan of Care to refresh the billing data.
     
     
3. If the claim end date has passed:
   
   
   • Check the patient chart for posted billable visits during the billing period.
     
     

For Per-Visit Billing Insurances:

1. Go to Claims/Auth > Chart of Accounts Settings to check for visit types and usual fee information
   
   
2. Locate and open the Visit Type included on claim
   
   
3. In the Fee Schedule table:
   
   
   • Find the specific insurance.
   • Make sure the Usual Fee is not set to $0.00.

Important: If the claim period ends next year and the amount shows as 0.00, it likely means that CMS final rates have not yet been released. Once CMS publishes the final rates, Synergy EMR will automatically update them, and the claims will recalculate to display the correct amounts. You’ll notice these 0.00 claims appearing on episodes starting November 3rd and later

Tip:  If all configurations look correct and the claim still shows $0, try regenerating the claim or contact Synergy AI/EMR support for further assistance.

This FAQ was generated based on Synergy AI/EMR App Version 7.0.38.36159 and Dashboards Version: 7.0.38.14741

Important: The information in this FAQ is based on the software version available at the time of publication and is subject to change. Please use the software responsibly. HealthCare Synergy is not liable for any issues resulting from outdated or incorrect use of this information.