Adjustments
What is the difference between X303 & X403?
What is pre and post payment?
What do write-off T-code start with?
What is W?
FC TN, non-contracted primary insurance denied due to untimely filing but was initially booked wrong due to a COB issue. DOS 08/26/2023 - 09/10/2023
***B1 W331 $126.89 CY09/10/2023***
What is incorrect Tcode? Correct Tcode is W778
This is the T-code used if primary Medicare advantage insurance assigned patient responsibility and Medicaid denies for Max allowed.
What is W771
Where can you locate the information needed to assign the appropriate level 4 PIC?
Powerchart and/or Millennium
How many total asterisks are needed for one adjustment request?
What is 6?
Write-offs are used to report what?
What is Loss in Revenue?
Aetna Medicaid paid correctly per contract minus two days. The balance on the account is $1190.00 However it should be $1200.00. DOS 04/20/2023 - 05/01/2023
***B1 X403 $(10.00) CY05/01/2023***
What is no error?
This T-code is used when writing off balance due to No auth because of a COBI?
What is W777?
What is ASTF?
Adjustments are used to reflect the difference between what two things?
Billed Charges and Payer's Contractual Obligation
NMCR Primary insurance paid correctly and applied $1200 patient responsibility. The balance is in bucket 2 and Medicaid denied for max allowed. DOS 04/20/2024 - 05/01/2024. How would you request the adjustment?
What is ***B2 W771 $1,200.00 CY05/01/2024***
Facility did not obtain authorization from the primary insurance. FC is TT. Balance on account is $911.00
***B1 W441 $(911.00) CY08/28/24***
Two-digit year & Brackets
Insurance is short paying, they reimburse a per diem rate. EOB is showing no denied lines and we exhausted all efforts of collection
What t-code and status code would be used?
What is A107 & Status 500
Facility was unable to obtain continued auth due to missing the re auth window from a strict frequency of every 3 days. What level 4 PIC would be assigned?
What is APYR?
Typically, contractual adjustments are made based off of this insurance?
What is Primary Insurance?
What status code is used when submitting a no continued authorization write-off?
ARA I - 555 after level 4 PIC is added
ARA II and above Status Code 500
MCD 2ndry is denying for max allowed with a MCR ADV is primary
***B1 W211 $75.00 CY01/01/2024***
What is T-code W211? Should be W771
This is the T-Code used to submit a write-off when the payer is denying for NCA but it is due to a discharge barrir where we were unable to release the patient.
What is A106?
Facility was unable to obtain continued auth due to tracking failures. What level 4 PIC would be assigned?
What is ATEC?
Inpatient remaining balance on account of $386.09. FC is TT. Per review, Insurance paid correctly. Patient was discharged on 07/07/2024. What would the request adjustment be?
***B1 X403 $386.09 CY07/07/2024***
Late charges of $(150.00) were added to the account after the final bill charges dropped. FC is TT and payer pays per diem. The patient was discharged 01/01/2024 How should the adjustment be requested?
***B1 W221 $(150.00) CY01/01/2024***
IP MCR Advantage paid correctly at 100% CMG and applied patient responsibility of $1632.00. Current balance on the account is $1632.01 & we received a max allowed denial from secondary Medicaid. DOS 11/21/2023 - 11/26/2023.
***B1 X404 $0.01 CY11/26/2023***B1 W211 $1,632.00 CY11/26/2023***
What is i T-Codes ?
On Medicaid, write-off T-codes are the same no matter if it is an IP account or an OP account. The only time IP/OP changes the T-code is when we submit this type of adjustment, what are those T-codes?
What is a pre or post payment manual adjustment?
IP Post X403 OP Post X404
IP Pre X303 OP Pre X304
ARA I should do what if they believe a NCA write off is needed?
Do review for level 4 PIC, add level 4 PIC and status to 555 for ARA II to review and submit adjustment.