Census
You check this box in census when a Medicare patient is out for 3 or more midnights and returns on Medicare.
What is reset MDS
Resident admits to facility on 10/15, CWF shows they have an active Medicare Replacement policy and Hospice episode that begins on 10/6, what is payer for this stay?
What is Medicare A
A patient admits as VA when you check the auth letter you see an electronic payer ID of “TWVACCN” what is their payer?
What is VA Triwest
You are setting up a resident in PCC that is Medicare advantage, what important set up needs to be checked “Yes” to ensure Medicare’s copy claim creates?
What is “Is this a Medicare Advantage plan?”
What report do I look at when verifying patients Medicare days are calculated correctly.
What is PDPM rate report
Resident admits under Medicare A due to an open hospice episode & active Medicare Replacement policy. The Hospice episode terms on 10/20, who is the payer on 10/21?
What is Medicare
Mr. Smith admits with a commercial BCBS policy, what is their payer?
What is BRA
Mr. Adams admitted today with Humana but on the CWF he has an open MSP, you have confirmed that the care being provided is not related to the open MSP, where in the patients set ups would you enter “NOT RELATED TO OPEN MSP”?
What is A/R Bill Set up
Where do I look in PCC to confirm residents begin date for start of wellness.
What is Level Of Care
Patient admits from the hospital for therapy due to a car accident, CWF only shows traditional Medicare, who is the primary payer?
What is MSP
What is the payer for a resident who has commercial insurance, and your facility is OON and does not have a contract with?
What is IHH – Insurance Other C PDPM
When setting up a BCBS commercial resident, what information do you need in order to choose the correct rate?
What is policy type
What is the claim called that is billed to Medicare to report that patient has exhausted days but remains skilled?
What is benefits exhaust claim
True or false, you are admitting a resident who has an open workers comp MSP with an effective date of 1/1/1993 on the CWF, you can set this resident up as Medicare primary because it is so old?
What is false
Name one of the four procedures that are included in the Medicare TEAMS model.
What is lower extremity joint replacement, surgical hip fracture repair, spinal fusion, coronary artery bypass graft, major bowel procedure.
What is required under the A/R insurance tab when setting up an INS resident in PCC?
What is auth number
You admitted a resident with an action code of “RL” return from leave when it should have been Transfer In “TI” what important clinical assessment will not be triggered?
What 5-day MDS
Patient admits on 10/10 with a hospital stay from 10/7 – 10/10, hospital records show 10/7 as an observation day, is this a QHS?
What is no
Which insurance payer’s auth start with “IPNAV”?
What is Wellmed
We admitted resident with payer of UHC in January, we billed those services and UHC denied because the plan termed 12/31, CWF now shows Aetna effective 01/01 after changing payer, what is your next step?
What is NOTE