Only in follow up
Name 3 of the most commonly used activity codes in follow up
ICPR, RIRV, RIFD, APPC, MRRH, IBSI, B1HC etc
What systems do we use to update an insurance on an account?
PM Office and RC9U
What it the first thing you should do on every account when starting followup
READ the ENTIRE account
what is a payment variance
When a claim is not paid correctly based on contract and/or the payer guidelines
What is the address of our office?
31 Research way
What is the patient non-compliant process
Bill pts if they fail to respond to ins or us in ref to getting the bill paid.
What needs to be scanned into RASI when doing an updated
Elig info
What is the difference between adding a note using an activity code vs adding a free text comment
Act code has function associated with it, i.e. sending acct to another unit, or pending it from the worklist.
Free text is only a note and does not count toward your productivity
What tools can we use to determine what the expected payment is
PIC, Medicare pricer, contract, fee schedules etc
Which staff members have worked in both recurring and regular follow up?
Nicole
Shobana
Joseline
How should you be prioritizing your work?
High $ to low $
Name 2 ways a person qualifies for Medicare
Age, Disability, ESRD
What is the difference between a reprocessing and an appeal?
Reprocessing is the request for the payer to review their initial decision
Appeal is a more formal process for challenging denial and is more comprehensive then a reconsideration
What is an acceptable variance?
Under $100 difference
When is our next day off?
Memorial day 5-26-25
What information should you always request from a rep when calling an insurace?
Rep name, ref #
What is a dual plan
Medicare and Medicaid HMO through same payer
Name something that is required in all notes
Phone #, initials, claim #
What is the APG fee schedule
The APG system is the payment methodology used to determine most Medicaid outpatient services.
Who recently became a grandparent?
Jesse
What is a FLUPPER?
My Follow uppers!
What would the correct COB order if the patient has:
D99
M31
B14
M31
B14
D99
How many times should you notate an account before you escalate to JOC or management?
3
Can we bill a secondary payer if the prime insurance denied the claim?
No- we only bill secondary payers when there is patient responsibility assigned
Who is the youngest person in follow up
Emely