Policies & SOPs
TRUE or FALSE: PSOs have to be done both over the phone AND in home.
FALSE: PSOs are preferably done in-home, but an exception can be made for it to be done over the phone.
The Payer Management site is located in which Department page on Pulse?
Strategic Innovations
What is the term used when a shift is processed outside of the regular payroll week?
Off Cycle
What is the time frame a Recertification Visit needs to be completed? (Hint: Numeric Day)
Between 5 Calendar Days of the end of the Certification Period (between day 56 - 60 of the current Cert).
TRUE or FALSE: Both the family and/or provider can request Aid Paid Pending (APP) in the event of an authorization denial.
FALSE. Only the family can initiate APP
When does a patient transfer summary have to be completed? (Hint: Scenario)
A change in condition requiring,hospitalization, or placement in an alternatecare setting.
A change in condition requiring services outside the scope provided by the division.
The Company is eliminating a particular service or closing the office.
Patient moves outside the Company’s service area.
The Company does participate in the patient/client’s insurance
Name 4 out of 8 ONE TIME Nursing Skill Competencies.
Pediatric Assessment
Blood draw (venipuncture)
Catheterization
Cough assist machine
CPT Vest
NG Tube Placement/Check
Non-invasive Ventilation (CPAP, BIPAP, PAP via Vent)
Wound Vac
Name all 3 ways you can verify Benefit Details for a member.
Eligibility Detail on the Payer Portal
Evidence of Coverage (EOC) / Certificate of Coverage (COC) / Explanation of Benefits (EOB)
Call the Payer Provider Services
Who initiates the review of auto closed notes and who "finalizes" the review?
FSG initiates review of auto closed notes by notifying the clinical team and the clinicians review and determine of the note is sufficient enough to be submitted along with the claim.
What does MVR stand for in regards to Patient/Nurse Transportation?
Motor Vehicle Report.
Explain the differences between a RDBD of Payer Management, Billing Team Lead, and Centralized Services Specialist?
Bonus Points: Who holds each title above for our office? (75 points each)
RDBD: Responsible for building relationships with different payers to expand Maxim's ability to provide services. (Wesley Dover)
Billing Team Lead: Responsible for assisting local offices with everything Payer and AR related (submitting claims, holds, etc). (Jenna Diaz)
CSS: Responsible for assisting local offices in review/entering data that relates to processing payroll (F&D, VSOC, 485). (Maya Kelly)
Name 5 out of 9 of the categories that go into the Scorecard?
Expired Credentials
Personnel Paid Count
Credential Accuracy Rate
Manual Checks
# Worker Related Holds
Payroll Submission Date
Payroll Accuracy
# of Office Holds
Zero Billed Shifts