Adjustments
Adjustment code # for balances under 9.99 with no outstanding on account
3005 SMALL balance - but use original denial when applicable
This is the Epic Default code, we NEVER use it?
3006
Final follow up documentation should include dates charges were held in coding when using this code
3036
What is a SOP?
Standard Operating Procedures
What is a SMART
Specialized Mentor and Rev-cycle Trainer
Adjustment code # where no authorization was obtained.
3033
Any adjustments using this code should be reviewed by coding prior to adjusting and documented in the final follow up note.
3032 and 3064
Always consider the root cause when using this code?
3041 Past filing deadline for an appeal and HIM/Coding or HIM vendor was root of delay in appeal. Coding correction not made timely, coding review not completed timely. Adj type should go back to the root cause. Should be rare. Watch for notes indicating information requested from provider.
If an email is submitted to payer how long to defer invoice?
7 Days
What is a KPI?
Key Performance indicators
Adjustment code # when the procedure is different than what is on the prior authorization
3039
When the invoice was filed late due to registration issues.
3049
Documentation Elements should include: Explanation of ....
SOP 1749
Explanation of insurance and patient payments/adjustments/denial received
· What action is being taken on the account
· Ending balance after action
· Responsible party for ending balance
How long do you defer a mailed appeal?
30 days
What is PE
Must document the date charge entered or the time the charge was in Physician Query to use this code #?
3062 - Verify with leader
Adjustment code # for the payor contractual
3019
How should you identify your follow up is due to a special project?
Note at top stating SPECIAL PROJECT
How long to defer if you requested an EOB and the payer says they will fax it?
7 days
What is a GiG ?
Something to do with goals which equals money
Use this adjustment code for 99439, 99490 chronic care management.
3074 Non Covered
What is the adjustment code if services are denied due to bundled?
3064
An appropriate action if you do not feel coding is resolving your issue.
Email to Carrie with ARDENT Coding Specialty in header and then Patient Guar ID #, Name, MR# DOB and TX # involved. Thanks
30 days
The associate will follow up with the payer to confirm the records receipt. Once confirmation is received that claim is in appeal or review status defer for 30 days.
What is QA?
Quality Assuance