Claim Detail
When working on AR follow-up, which of the following should be prioritized?
A. Patient satisfaction surveys
B. Claims paid in full
C. Recently submitted claims under 10 days old
D. Claims over 90 days old with high dollar balances
D. Claims over 90 days old with high dollar balances
TFL to bill the PT is _____.
A. 1 Year from DOS
B. 1 Year from Denied date
C. 180 days from DOS
B. 1 Year from Denied date
What is the Cerner action code for Sub status code
A - UNTIMELY FILING ADJUSTMENT -AUTHORIZATION ADJUSTMENT
WONOA
ABN
Advance Beneficiary Notice
Scenario:
A partial payment received matches the expected reimbursement. What do you do next?
A. Bill the pt the remaining balance
B. F/U with the payor for the remaining balance
C. Adjust remaining balance
D. Send to the Beacon biller...they love that
C. Adjust remaining balance (if the expected reimbursement is met, adjust regardless of the denial.)
If ANTHEM partially paid the claim & partially denied the claim as Level of care. Per WORKFLOW found it is already assigned to ROBOT. What is the next action?
A. Move the claim to non-workable
B. Appeal the claim with MR
C. Send the claim to coding team
D. The robot is all knowing...they can handle it
A. Move the claim to non-workable
What is the Cerner action code for Sub status code
B - REQUESTING TO SUBMIT MEDICAL RECORDS THRU MAIL
B - REQUESTING TO SUBMIT MEDICAL RECORDS THRU MAIL
DME
Durable Medical Equipment
Scenario:
If a claim denies for no auth and a retro auth is not possible. How do you proceed?
A. Adjust with code 3140 and apply action code WOFTF
B. Adjust with code 3140 and apply action code WONOA
C. Call the payor and ask them to pay anyway
D. Note the account that "retro auth not possible. Following up in 30-45 days"
B. Adjust with code 3140 and apply action code WONOA
If a claim is denied for bone density CPTs (e.g., 77080) due to mutually exclusive procedures being performed on the same day or in the same setting, what is the next action?
A. Move the claim to coders
B. Resubmit the claim
C. Appeal the claim with Bone Density record
D. Wait...the problem will resolve itself
C. Appeal the claim with Bone Density record
What is the Cerner action code for Sub status code
G - NDC REVIEW
NDCM
GHP
Group Health Plan
BONUS GAME -
1. WORDLE
2. Pick another Question :)
Congrats!
What is a valid Place of Service (POS) code for an office visit?
A. 22
B. 11
C. 21
D. 24
B. 11
What is the Cerner action code for Sub status code
F - PROVIDER ISSUE
NOTENR
MSP
Medicare Secondary Payer
What does FFS mean in the context of healthcare billing?
A. Fast-Filing System — Accelerated claim submission
B. Fast Food Style — Summary of charges and payments (but quick and delicious)
C. Fee-for-Service — Payment model where services are billed individually
D. Federal Funding Schedule — Government payment calendar
C. Fee-for-Service — Payment model where services are billed individually
Which modifier is used to indicate that a procedure or service was altered but not changed in its definition or code?
A. Modifier 25
B. Modifier 59
C. Modifier 22
D. Modifier 51
B. Modifier 59.
What is the Cerner action code for Sub status code
D - BILLED TO PATIENT
BALPT
HCPCS
Healthcare Common Procedure Coding System