Processes
where can you find follow up processes
OneNote, Intranet, W drive
CMC guidelines
CMS guidelines refer to the rules and standards set by the Centers for Medicare & Medicaid Services
What carc code is used by split plans when neither will take responsibility for services billed?
109/ MIS-Routed
Who is responsible for qualifying Medicare for patients at SBUH?
WE ARE!
How many licks does it take to get to the center of a tootsie pop?
1.....2.....3....crunch
3 licks!
Fun Fact: Nicole's great grandmothers nickname was Tootsie. :)
Name the process used for pharmaceutical coding review?
CDM process/ CDMI
Condition code
Condition Code is a two-digit code used on UB-04 forms to convey specific circumstances or conditions that affect the billing or processing of the claim.
Why do we send bill type 130
Reporting Only
What codes are brought up most often in our huddles?
STAT charge codes
What is CRP's sons name?
Ethan
What processe goes hand in hand with the 28 records process?
How to demand a bill
Recon vs Appeal
reconsideration is asking that the claim be reviewed and correctly reprocessed.
Appeal means we request a formal appeal and supply back up information and/or documentation to support our argument
What is it called when a patient has 2 BX policies and BX cannot get the claim to process under the correct prime policy
Blue on Blue
Which process is our most lengthy?
RIRV no auth process
What is Nicole's cats nickname? (2 poss ans)
The mad shitter or Chicken
Where can you find copies of paper EOB's when there is no EFT?
W drive, daily cash posting, follow process titled "finding payment in W drive"
GME
General Medical Expenses- A small payment received directly from Medicaid on INPT accts when the patient has a Medicaid HMO as the prime coverage. This it due to us being a teaching hospital.
How many days do we have for timely filing/ follow up with EMBLEM
280 days!!!!
Can you move $75,000 or more in an encounter?
YES, moving is fine. You CANNOT adjust anything over $74,999.99.
What town does NM and AB live in?
Middle Island
How do we handle paid to patient accounts?
Bill the pt
NDC
National Drug code
What does JOCI do?
Add 28 R to JOC account,
Name 2 of the ICARE values
Integrity
Compassion
Accountability
Respect
Excellence
Which 2 months are tied for the most Flupper Bdays in them?
Sept and Dec
3 each