APR/DRG
Under this methodology, a facility's reimbursement is based on the severity of a member's diagnoses, rather than the number of inpatient days?
DRG
Interim claims will be submitted with which bill types? (name all three)
112-114
For SDAD claims, the amount for value code 80 would be?
blank or zero
For split enrollment, services paid via DRG method will be paid by the payer with which the recipient is enrolled on which date?
date of discharge
With few exceptions (bill type 12x and maternity and newborn unauthorized care), this is required on all inpatient claims?
Prior Authorization
DRG claims are inpatient acute care claims which are identified by which bill types?
111-119
This inpatient claim bill type will cover the admit date but will not contain the discharge date? (must also be billed in no less than 30-day increments)
Bill type 112
SDAD claims are not priced under DRG, instead they are treated as if they are which type of claim?
Outpatient
Which occurrence code is required on all Dstat 20 claims (along with a date)?
Occurrence code 55
Inpatient claims should have which value code listed with the number of bed days billed in the amount field?
80
For DRG claims, all ancillary charges are denied with which dispo?
95 - included in DRG
For bill type 113, bill type 112 must be billed before this may be processed. If no 112 bill type is found, which dispo would you deny with?
505 - no initial bill found
SDAD claims will have which bill type?
111
Situations where ancillary services are performed before the member is admitted for their bed stay on inpatient claims are known as?
Late Admission
Inpatient claims for a newborn will also require which value code with the weight listed (in grams) in the amount field?
54
Which revenue codes must be billed on the claim before any ancillary charges?
Room and Board
This inpatient claim bill type will contain the discharge date but not the admit date (this one is not required to be billed in 30-day increments)
114
SDAD claims w/ dstat 20 will be priced under which methodology?
DRG
These are 7-digit alphanumeric codes (different from a diagnosis or procedure code) that are located on pg. 4 of IDX?
Principal procedure codes
Which kind of diagnosis is required for all inpatient claims?
Admit diagnosis
Room and board days are keyed into which field in IDX?
Days
The preferred method for resubmitting an interim claim is the void claim process - submitted under which bill type?
118
For SDAD claims, the room and board line is denied with which dispo?
107 - accom. day disallwed
These indicators are required on all inpatient claims?
POA (y/n)
If a patient dies during their IP stay, which discharge status is required?
Dstat 20