Insurance
The system/ portal is most commonly used to verify eligibility before billing?
What is Availity - reconsiderations, verifications, appeal, claim status, EOBs, Paid not Posted, ETC
-correct branch
-correct units
-correct insurance
Rx means__ / PN means __
Prescription / Progress notes
- CMN/ RX are the same! *must be signed/dated*
This should be the first checked when changing insurance?
What is INSURANCE VERIFICATION
What is HDA - when is it used?
-High Dollar Adjustment
-Over $1,000
*balance transfer does not require HDA -50pt bonus)
-PN says every 8 hours = __ per 1 mo and __ per 3 mo
- 120/ 360
- 90, 270 (3x per day, 30 days per mo, 90 per 3 mo)< THIS IS PER INSURANCE SOME ARE 28 DAYS OR 82 DAYS
Medicare Part B is inactive, what other section do we look at? (4)
PART C
MSP
Home health
Hospice
Explain Branch Rebill
-check contracting spreadsheet
-update sales order that is being rebilled
-update personal tab branch
-update template
-what services do not have template (50pt bonus)
sending notes for incontinence while billing for another product creates what problem?
Denial for not covered - you cannot send incont notes for a wound care patient! KEEP READING!
What is the first step when a payer rejects a claim due to eligibility issues? (2)
Confirm Eligibility
What must be checked when rebilling?
-every tab
-ins tab must have "include payer.." checked for primary and secondary
-confirm ins verified for DATE OF SERVICE
-always double check ITEMS tab - is insurance correct? are procedure codes selected?
RX and PN must have: (hint: 8)
-pt name
-pt dob
-start date
-LON
-phys printed name/ NPI/ phys signature/ date
-item
-qnty/ foc
-dx
Explain the entire process for Need New Insurance.
-1904
-3 contact attempts by front end ONLY
-balance transfer
-AR ALERT
Explain Corrected Claim vs Fresh Claim rebill
-refer to SOPs
Wound Care documents include and must be within __
rx, pn, and wc documentation (size, slough, debreidment, thickness, stage, etc)