CMS Pricer
This is known as the Medicare Provider Transaction Number.
What is "PTAN"?
This is the purpose of the Adjustment Override Function.
What is to "Reduce Contractual Adjustment Requests"?
This link on the Cash Rep Portal utilized to upload your PMF documentation for review.
What is "Cash Review"?
This is the Payer Issue Code for a recoupment request.
What is "RCOU"?
This is used as a guide to ensure we have notated all necessary information showing we have exhausted all efforts to receive payment on a claim.
What is the "Appeal Checklist"?
This is the month that Medicare updates CMG annually.
What is "October"?
This is the platform and tab used to update an existing insurance.
What is "Millennium & Insurance Tab"?
These types of payment postings do not require a PMF...
What is "Manual Postings (Posted in IPscan)"?
This PIC is used when we submit a refund and the insurance also recoups.
What is "RFRC"?
This person is responsible for confirming if the appeal is necessary and all documentation presented is correct.
Who is the "Sr. ARA"?
These are the guidelines the CMS Web Pricer tool follows when calculating estimated payments for Medicare, Medicare advantage, or commercial plans paying per CMG.
What are "Medicare Guidelines"?
This is the Millennium accommodation selection that is equivalent to accommodation code 36 in Patcom.
What is "Private Level 2"?
This is who your leadership would escalate an email to for review if a request was not completed by the Cash team and it was valid.
Who is the "Cash Manager"?
This is the number of hours Medicare allows a patient to be readmitted to an inpatient facility after discharge from an Encompass Health facility.
What is "72" hours?
When placing an appeals request we use this activity code and this status code...
What is "430 & 515"?
This is a 2-digit code that identifies how a patient was discharged from our facility.
What is "Patient Status" or "Discharge Status"?
This is the portal utilized when an accommodation code needs to be updated.
What is "add to Accommodation Code/SCP Updates Portal"?
These are the 3 reasons for requesting a PMF.
What is the process for the reasons: "Auto-posted payments no belonging to patient account (interest/MR), Auto-posted payments for patient accounts (misread T-codes/account #), and Transferring patient payments"?
These are the 2 locations we would check to confirm what discharge disposition we have listed prior to calling the insurance if an overpayment recovery letter is received stating the claim was over paid due to the patient being transferred to another facility.
What is "Patcom/PI screen & UB04"?
What is "Once the payment is received"?
This is the year the CMS Pricer will return a rate for if the billed DOS are 9/12/2023 - 10/03/2023.
What is "2024"?
This is the next action step if 2 overrides were previously attempted and were not successful.
What is "Place a manual contractual adjustment so the true balance is correct"?
These are the required attachments needed when submitting a PMF.
What are "Payments/Adjustments screen print-out or screenshot, available remit pages, checks, and receipts "?
This is requested when the offset is unknown.
What is "Negative Balance Transfer Sheet/Report"?
If a Representative advises of an appeal denial, this is what we request to be sent if it hasn't already.
What is "Determination Letter"?