Adjustment Codes we use
Name the adjustment code for sequestration.
What is MS
Where do you specifically find the BLS outsourced amount?
What is in the amount due on the recovery screen
Who are you sending adjustment request to?
What is the lead and emailing the lead and trainer
What must you do prior to closing an account but after your adjustment request is approved?
What is add adjustment and amount to bridge
In the Adjustment template below that was approved, what does UA1 signify
BLS Outsourced Amount= $5284.35
Expected Reimbursement: $5,284.35
Claim Paid = $0
Bridge Adjustment Code= UA1 $5,284.35
What is appeal lost at the first level
Name the adjustment code for contractual.
What is CW
What locations can you find the expected reimbursement amount?
What is the calc box on the recoveriy info screen or the reimbursement tab in epic
Name 1 example or situation when you would send for adjustment request
What is when appeals are exhausted, when it is timely, when it is no longer in our WQ, when it’s a one and done
What action code do you use to close an account after putting in adjustment but there was a payment we could claim?
What is DPF p stands for pay
In the Adjustment template below that was approved, what does PT signify
BLS Outsourced Amount= $5284.35
Expected Reimbursement: $5,284.35
Claim Paid = $0
PT-$1,000
Bridge Adjustment Code= PT $1,000
What is patient responsibility
What adjustment code may be used along with placed in error reason code and may be used to adjust an account due to not being able to work the account?
What is PIE/RCQ (commonly used when removed from Epic WQ)
Who does the adjustment request get sent to as collector while in training after you receive client access and what action code do you use?
What is the lead and Dorr
What is the threshold for Expected reimbursement when we send for adjustment?
What is below $1,000
What action code do you use when you close an account to signify it was adjusted in full?
What is DAF (A stands for adjust)
In the Adjustment template below, what are the names of the 2 adjustment codes listed and what do they mean
Outsourced Amount - $1807.77
Expected - $1465.24
Primary Paid - $1229.16
Secondary Paid - $272.67
Adjust MS - $25.09
Adjust CW - $280.85
What is sequestration= MS=
Claim reduction due to 2% Medicare Sequestration
What is Contractual= CW= Contractual Write-off
Where can you locate in bridge what adjustment codes to use?
Under the Adjustments and Payments tab
What is the adjustment template format and other than sending to the lead, who else are you emailing when requesting approval
Bls outsource
Expected
Paid
Adjustment code
Reason for adjustment
Epic balance
Epic Adjustment
Who is Your trainer
Who does the adjustment request get sent to as collector while in training prior to receiving client access and what action code do you use?
DAPA, Lead
True or false: you can close an account without adding adjustment codes to Bridge if there is adjustments
What is False
If Requesting adjustment due to all levels are exhausted and you determined the only adjustment would be the appeal was lost at the second level, what would the adjustment code be?
What is UA2
On an EOB, where might you look to determine what adjustment is needed?
What is under remit codes also found under payment amounts on EOB.
What goes under the field: reason for adjustment in the template?
What is Revecore Denial Review-Followed by a lengthy description including reason for adjustment and history on claim
How can you check your DAAs and DADs if you do not get an email back from your lead?
What is Pull your name as collector and search for DAA (approved) and DAD (denied)
What should the final amount due equal to unless there is an overpayment when you have adjusted the account?
What is zero
On the EOB, under the remit codes Patient responsibility is listed as $1000. The appeal was lost and now appeals are exhausted at the first level due to a one and done for this client. The contract amount in Bridge listed as $5000, the expected reimbursement was $4000 and the final amount due was $5000. No payments were made. Write out the completed Adjustment template request you would notate in bridge to send
What is:
Outsourced : $5000
Expected : $4000
Claim Paid: $0
Adjust UA1 : $4000
Adjust PT:$1000