General
What is XX modifier
CPT
Current Procedural Terminology manual
Healthcare for elderly, disabled, and those with ESRD.
What is Medicare?
Which adj code is used for OOS MA patients, EMA Coverage only, and Restricted patients in which we have attempted to obtain auth?
What is the timely filing for these payers: Medica, HP, Itasca Medical Care, Optum VACCN, Primewest, Select Care, So Country
180 days from the Date of Service
Denial code CO16/M119
Invalid NDC.
ICD-10
Internaltional Classification of Diseases; 10th edition
A traditional insurance plan that provides payment, either to the provider or the patient for each medical service provided is?
Fee-For-Service Plan
if you wanted to review the percentage or accounts that are older than 180 days, you would look at this report
Account Aging (HB Aging summary/Active AR) found on your dashboard.
An A6 condition code tells the insurance co what?
The A6 condition code in Medicare pertains to pneumococcal pneumonia and influenza vaccines. It signifies that these vaccines are paid at 100% coverage.
This Modifier is used when the “Service is not covered by Medicare by statute”
What is GY modifier
To force a charge to fall on a 1500 if it is currently falling on a UB is...
@PUT CHARGE ON 1500@
A fixed amount that a patient pays when the patient receives hospital services is called a?
Co-Payment
How often should one clear their filters on their wq's to ensure they are not missing working any accounts that didn't hit their filters?
What is WEEKLY
What command in Epic Forces claim to have external edit after hitting Rycan with claim state 23 (Hold the claim in Rycan/Trubridge)
What is HOLDRYCANUB for a UB or HOLDRYCAN1500 for a 1500 form
Denial Code CO22 means?
This care may be covered by another payer
99201 is an example of what type of code?
CPT; E & M-Evaluation and Management
Term that indicates the patient's request that the insurance carrier pay the provider directly is?
What is Assignment or Assignment of Benefits?
What Epic adj code is used for Inadequate Documentation (INS) ADJ?
What is 430. Ex. 30 day rule, inadequate consent form
Coding
what is the correct adjustment code to use for Untimely Billing (ins) adjustment? Hint, it is NOT 494
What is adjustment code 302 UNTIMELY FILING BO (INS) ADJ
Third party payors make payments based on care that is reasonable and necessary for the patient based on evidence-based clinical standards of care.
What is Medical Necessity?
These plans aim to control health care costs while improving preventative care.
Managed Care Plans
What is BXBS timely filing eff 2.1.23?
180 days
How much per day is charged for a patient to stay in Alternative Care for a day?
What is $500 a day