Insurance
Anthem - B15
True or False: It is okay to send Rev code 258 to the coding department for Anthem-B15
False
What does HX stand for?
History
The claim partially paid but we received the Expected amount as per Pricing details. What do you do?
Adjust the remaining balance
Does Revenue code 250 require both a National Drug Code and HCPC?
No, an only NDC
What year did our partnership with Beacon start?
2022
What website should be used to verify a patient’s eligibility in Medicare, SNF or Hospice?
WPS
What does DX stand for?
Diagnosis
If Theraphy claims are getting denied for No Auth and if Auth is present in the claim form, what do you do?
Need to call the payer and send the claim back to be reprocessed.
When a procedure is billed with GZ modifier and denied by Medicare. Should the denied procedure be billed to the patient?
No, this is to be adjusted as not meeting MN
Contractual Adjustment Codes
What is the CA code for Credit?
What is the CA code for Debit?
Credit - 2050
Debit - 2051
Does Indiana Medicaid accept corrected claim TOB ending with 7?
No
What does PA stand for?
Physician's Assistant
If a claim is denied for a CPT or Dx related issue, And the coder responds as Coding is correct nothing to revise it, what do you do?
Need to check AAPC for compatible codes and if DX or CPT is compatible team needs to appeal, If both is not Compatible team can move the claim for Adjustment
Out of State Medicaid - TFL Adjustment.
We have to perform 25% of charges as ___ & remaining 75% charges to be adjusted as ___. (Both PB and HB)
1.Timely filing adjustment
2. Contractual Adjustment
Are physician services covered under Medicare part “A”?
No, part B is responsible for physician services
What does CWF stand for?
Common workman file (will indicate when COB was updated with Medicare)
You have a PR96 but Not Medically Necessary denial, what do you do?
When insurance denied claim as Not medically necessity under as PR - 96, We should not bill patient and instead send it to coding to check if any supportive DX could be added.
True or False: If Revenue code 250 is denied for co-97 this service is included in another procedure billed on the same claim for Medicaid plans. This balance should be adjusted to contractual.
True
What are the only two acceptable POS for Telemedicine for Medicaid of Indiana?
10 and 02
What does AMA stand for?
Ask me anything....I mean against medical advice
Patient Billing
We have crossed TFL and there is still a balance on the encounter level. What do you do?
If we crossed the TFL from the Last Processed/Denial Date then we can Adjust the balance in Encounter level with the Alias Code (3010) only after moving the balance to selfpay.
When an Acute claim is denied for a patient being enrolled in Hospice, what actions should be taken to resolve this account?
Call Hospice entity to verify Hospice dx. If Enc dx is unrelated to Hospice, so pt reg needed to be updated with 07 Cond Code and send to ABR to send clean claim 131 with Cond Code 07.
How many times has David spilled coffee on his Nintendo Switch during a call (I was not playing the Switch at the time...it was just plugged in next to my computer)
1...that you know of