NHQ/MDP 90X
What is the process to submit bills for MDP or NHQ?
Complete MDP/NHQ Cover sheet, attach the bills only, and complete an admin/assist request.
How soon should a new claim be reviewed upon assignment?
within 30 mins
That's too low of an offer! What should be your response?
Am I missing anything specific that you feel should be considered? I want to work with you on ensuring you receive a fair settlement. I understand you are not satisfied with the amount; do you have a specific amount in mind?
Can you tell me how you’ve come to that amount?
By Federal Law, we are required to identify any injured party who is or becomes _____ ______ during the life of a claim.
Medicare Eligible. By Federal Law, we are required to identify any injured party who is or becomes Medicare eligible during the life of a claim.
What is Calvin Henry's famous slogan: 2 words
Let's Rage!
The CPT code 99202 indicates that the patient is an existing patient. Correct or Incorrect?
This statement is incorrect. The 4th digit in the code “0” indicates that the patient is a new patient. If the 4th digit were a “1”, that would be indicative of an existing patient.
When should you present an offer per the UIR process?
Same day coverage and liability is resolved.
Its not about the money? What should be your response?
The only way for us to compensate you for what you’ve been through is with money. Please tell me if there is anything I am missing or that we have not talked about.Try to tie money to something that they missed.
At what age do we consider that an injury party may be Medicare Eligible?
Older than 65 or turning 65 this year.
Monetary compensation for medicals bills and lost wages is called?
Special Damages: special damages are monetary damages that the injured party sustained as a result of the loss such as medical bills, lost wages, and “other” economic losses.
The purpose of the Initial Evaluation and Management is to determine_________?
The purpose of the initial E/M visit is to determine the patient’s medical history, conduct a physical exam and determine severity of injury and/or illness. In addition, a treatment plan may be prescribed.
If your initial offer is declined, what are the next steps you should take?
Identify impediment (why?), solicit a demand, review for a counter offer
My friend / relative was in an accident and settled for more than what you're offering. What should be your response?
While I’m not familiar with your friend / relative’s injury claim, I’m very familiar with yours. I evaluate each claim based on the merits of that individual claim. The offer I made is in line with everything I understand about your injury.
What does BCRC stand for?
Benefits Coordination & Recovery Center (BCRC) consolidates the activities that support the collection, management, and reporting of other insurance coverage for Medicare beneficiaries.
What injury best practice should be run at the start of every injury claim? HINT: Acronym
SNAPV(SSN/Name/Address/Phone/VIN). Helps r/o prior losses, injuries, UPD, additional contact info
The ____ is a guideline based on a healthy individual. It represents the maximum healing time expected for the specific condition reported. They are based on a synthesis of medical practice guidelines and claims data analysis.
ERD (Expected Recovery (Release) Date) Each claim must be individually analyzed to determine how much treatment is reasonable. This could be more or less than the ERD. When you’re evaluating an injury claim, you’ll want to pay attention to the length of treatment (i.e. the “Duration of Care”) and whether that duration exceeds the ERD. If it does, look back to available documentation to determine whether there are any findings that would warrant an extended duration of care.
We accepted 100% liability and have 25/50k limits. The CD went to the ER on DOL and received a CT scan(s). What should you do first prior to making an offer?
Call the hospital to confirm the billing amount to assure we will have sufficient limits and incur an adequate amount. (Review w/supervisor if needed)
Should I hire an attorney?
I am sorry if you're unhappy with how this is going. You have the right to get legal advice. However, I'd like to continue to work through this claim directly with you to come to a resolution we both feel is fair. Is this possible?
Which specific document should we ask someone who is Medicare Eligible to sign and return?
Consent to Release
What letter should be sent out after any UIR settlement?
UIR Confirmation Letter
Name 3 Claim types/elements that would not qualify for NHQ
Bill less than $400, Bills with known attached liens, SIU involvement, Collateral source paid bill, Fatalities, Full/Final settlements, UM/UIM claims in AZ, Shared liab claims
Which screens should be fully coded prior to closing any BI feature?
Injury Party screen(critical data), Medicare Screen, Evaluation/Negotiation Screen, Settlement Screen
Where can you find the Addressing Customer Concerns job aid?
Progressive Injury (URBI) Management site.
Which letters should be sent once we confirm an injury party is eligible or receiving Medicare?
M1 - Medicare Notice of Claim, U3 -Medicare Notice of Lien, M3 or M6 (Medicare Notice of Settlement) if settled within 90 days.
What are the 5 communication behaviors?
Respond with Urgency, Explain the Process, Keep customer up to date/honor commitments, Advocate, Listen Actively