Verification
If the facility is only able to verify the provider, facility name, address, and fax number; what do we do with the request?
What is send the request?
Do medical claims provide enough data to provide an accurate picture of the patient's overall health?
What is no?
If the facility wants to upload the records to our portal, what web address do I tell them to upload the records?
What is submitrecords.com?
When searching the Upload Portal, what shouldn't we remove?
What is the asterisk symbol?
Before placing the call, you want to refresh yourself on the Needs DQA process. What page of the guide does this begin?
What is page 13?
What is confirm the target fax was received?
You call the facility, reach the receptionist, and inquire about the medical records request. The receptionist proceeds to asks whether this request is for an audit. You inform them it isn't and that it's part of the _________ process.
What is Risk Adjustment?
When the facility is having a difficult time uploading the records and we begin to go through troubleshooting, what's one of the questions I should ask?
What is browser, file type, file size, password, or portal down?
If we're unable to locate the records and it's been more than twenty-four hours since they were uploaded, what would be our next step?
What is ask the facility to re-send the records?
A provider tells you they are experiencing problems with the Upload Portal and you're having a hard time remembering troubleshooting steps. What page of the guide should you refer to?
What is page 50?
Should we search for duplicate sites/RID's on every Verification Call or only when the facility says they've received multiples calls?
What is search for duplicate sites/RID's on every call?
Name one reason Risk Adjustment is important?
What is financial benefit to health plans, prevents substantial money loss, supports government reimbursements, or additional support for sicker population/patients with chronic conditions?
If we search the upload portal by the reference number and date provided and no results generate, what should our next step be?
What is adjust the dates?
If the facility says they are understaffed and a years worth of records is going to take them a long time to process, what should we offer to help them expedite the request?
What is offer specific dates of service?
We need to locate the steps on how to search the Record Tracker. What page in the RMS Retrieval Guide does this process begin?
What is page 55?
If we call medical records twice and reach a voicemail, what would be our next step?
What is call the main line/select different extension?
How is Risk caculated?
What is Risk Adjustment Factor (RAF)?
What do we use the record tracker for?
What is to see where records were associated?
What is the Hierachal Conditions Category (HCC) model for?
What is avoid counting similar conditions?
The facility asks whether this medical records request is for an audit and you freeze up. You remember there's a questions commonly asked by facilities section in the guide that addresses this. What page number is it on?
What is page 153?
If we ask the facility for a commitment date and they say no, what would be our next step?
What is express urgency and push for another commitment date?
Name one benefit that Risk Calcuation has?
What is predict future medical costs, manage patient health, or benchmark provider performance?
If we're unable to locate the records in the Upload Portal or Record Tracker, what would be our next step?
What is search RMS for duplicate requests.
Should we only express urgency when the facility says they can't agree to a commitment date or should we express urgency from the start of the call?
What is express urgency from the start of the call?
You hop off a call and want to strengthen your understanding of Risk Adjustment, you remember there's a section in the guide on this. What page does this explanation begin?
What is page 163?