QA
In the QA cheat sheet, where can you find information/notes about file entry topics?
Quick notes
If a file is pending for information, what status would you use in the "referral details" and "referral tasks" sections in LR?
Referral Details: Under Review
Referral Tasks: On hold
You have a PRO or ANS file that needs to be sent to adjudication, which status would you use in your claim status note in IIONs?
Pending facility adjudication for BOTH PRO and ANS files.
Note: we do not use the pending professional adjudication claim status.
If you need to find information on how to process corrections, where would you go in the DE Splash page?
Training section > Corrections page
You have received a trifecta file that includes (SWM) Southwest Matrix Anesthesia, PLLC as the ANS entity. Are you to enter this file?
No. We do not enter Matrix (M) accounts.
If you receive a file that does not have a QA sheet, what are you to do?
Enter the file as much as you can, call out/pend the file for required items (i.e.: ARS docs, FAN checklist, Op report, coding sheet, ID, ins card, etc.), note that there is no QA sheet for account and place file in pending info. Make sure to send an email to management to let them know.
How often do you have to review your LR on hold files?
What do you link the PRO and ANS to?
Always refer to QA to make sure; however, we typically link PRO > FAC and ANS > PRO.
If you need to request for a group name to be added to the group name list, who would you email?
Send an email to the following and cc' management:
Liliann Herrera
Emalie Galindo
This information can be found on the "Data Entry Contacts > Group name contacts page" in splash page
For the account (STA & STA-D) South Texas ASC, LLC, what is the ANS pricing multiplier?
--ANS Pricing: Use $1900 multiplier
For Missouri Commons, what is the number that the total of the supplies in each rev code is to be multiplied by?
15
One week from the date that you reviewed the file in LR.
If the patients address or claim address has an additional +4 on the zip code, where would you put the +4 digits of the zip code?
On the zip code line, in the second box after the "+" sign
Frequently asked Questions section > EOD format page
For the account (UIA) Utah Intermountain Anesthesia, LLC , which modifiers total 1 unit?
--Modifiers P3, 22, 23 = 1 unit
For Oklahoma Commons Surgery Center, LLC, if you see any J code that is listed on BOTH the supply and coding sheet, are you to enter the code twice?
No. If you see a J code on both the supply and coding sheet. Only enter the J code on the coding sheet. The J code on the supply sheet will be disregarded and not included in supply pricing.
Per QA: --IF YOU SEE ANY "J-code (except J2001)" listed on Supply list and Coding Sheet - Coding sheet is the only one that counts Bill as REV 0250 with corresponding CPT J-code. Disregard from supply doc.
For collaboration files in LR, if the file is good to and there is nothing missing OR if the admin checklist is the only thing needed, what tag would you add under the "referral details" section?
Collaboration Complete
Patient First Name: Mary
Patient Middle Name: Anne
Patient Last Name: Poppins
How would you enter this patients name in IIONs? If the patient had an middle initial (A), how would you enter their name in IIONs?
First name line: Mary Anne
Last name line: Poppins
First name line: Mary
Middle name line: A
Last name line: Poppins
If you need to know which accounts to work first of the files that you were assigned, where would you go to find this information in the DE Splash page?
Frequently Asked Questions section > Client Priority List page
You have received a ANS FILE from (BTA) Bravo Two Anesthesia, LLC and on the ANS record/coding sheet is the following information:
ANS code: 00563
DX code: M16.52 M54.50 M72.12
Ans start time: 10:15
Ans end time: 11:30 (no recovery time)
Modifiers: QZ 22 QS 23 P3
How would you enter this in IIONs (show us) and what is the amount of the units?
Code: 00563 (25 units)
Dx codes linkage/ for pointers:M16.52 M54.50 M72.12
Rev code of pointer: ABC
Modifiers (in order): QZ 22 23 P3 QS (3 units)
Units: 75 (time)
Price: 62,700
Total units: 33 units
00563 (25 units) + 75 mins (5 units) 22 23 P3 (3 units)