Revenue Codes
This revenue code is typically used when therapeutic exercises are performed using elements such as light, heat, cold, water, and electrical stimulation.
What is Rev code 420 Physical Therapy?
This is the modifier used when billing for physical therapy
What is modifier GP?
This is how to tell if a specific cycle is open
What is there is a balance in the cycle
Insurance reimburses $100.00 PV. The patient was seen a total of 6 days for the month of October. This is the correct reimbursement rate for October cycle?
What is $600.00?
This is the TOB we send when sending an Outpatient corrected claim
What is TOB 137?
This revenue code is typically used when services are provided that assist a person with impaired communication skills
What is revenue code 440
This is the modifier used when billing for occupational Therapy services
what is modifier GO?
this is the link utilized when needing to review cycle balances
What is the BS Link?
This reimbursement rate has to do with both the amount of visits the patient was seen and the different therapies provided each visit
what is PDPV?
TOB has 3 digits. digit 2 signifies this...
what is the type of facility services were provided?
T/F: We typically will still have revenue code 128 on our outpatient claims.
FALSE
This is the modifier used when billing speech therapy services
What is Modifier GN?
Once the remaining balance in a cycle is solely PR, we need to do this to the cycle in the BS link..
What is set the cycle to patient responsibility?
An account reimburses 175% Medicaid F/S. If the insurance pays correctly, the EOB will show...
All line items paid
This is the TOB used for cycles in the middle of the stay that do not include the discharge or admit date for an outpatient account.
What is TOB 133?
This revenue code is typically used when therapeutic services are provided that assist individuals improve daily living functions
What is revenue code 430 occupational therapy?
"The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated" is a denial that is fixable by adding this modifier to the claim?
What is modifier 59?
Most Medicaid states monthly cycle bill for OP accounts. This state requires daily billing for OP.
What is MA MCD?
An insurance reimburses 50% of billed charges. TC for Cyc 1 is $1245.00, we can expect the insurance to pay this amount
What is $622.50?
This TOB is used for the final cycle on an outpatient account
What is TOB 134?
Briefly mentioned in training - this specific is not covered by Medicaid and when denied we will submit a c/a to close the account not a w/o
What are hot and cold packs?
PA Medicaid has special billing requirements for outpatient claims. Please provide information on what the special requirements are and what each are used in place of.
What is Tcodes vs CPT and U8 vs 59 modifier?
Scenario: OP account has two cycles open and a balance of $279.00 left in bucket 1. Cyc 1 has a balance of $321.00 and Cyc 2 has a balance of $(42.00). We reviewed cyc 2 DOS 8/1-8/31/24 and determined that the insurance paid correctly, and this cycle should be closed. this would be the correct adjustment format and status we use for the adjustment request.
what is ***B1 X404 $(42.00) CY08/31/2024*** & status code 512 becasue overall acct is in a debit balance
Scenario: insurance pays PDPV $40.00
cy1 Information:
8/1 PT, OT, SP
8/2 PT OT
8/5 PT OT
8/10 PT
For this cycle, the correct est reimburse rate would be..
what is $320.00 ?
Each Discipline per visit will reimburse $40.
8/1 3 disciplines * 40 = 120
8/2 2 disciplines * 40 = 80
8/5 2 disciplines * 40 = 80
8/10 1 disciplines * 40 = 40
120+80+80+40
What is TOB 131?