Billing
A/R
Medicaid/Patient Liability
Other Payers
Misc.
100
When is the deadline for PC billing?
2nd Business Day of the Month
100
Should your aging be run by payer or payer type?
Payer type - we need to include all the Medicaid pending payers to monitor!
100
True or False - Medicaid allows for deductions of Life insurance premiums
False
100
True or False - Medicare and Managed Care cover transportation charges
False - Patients can submit our invoice to their insurance to get reimbursed on some occasions, depending on the plan, but they need to discuss that with their ins. company and pay our bill.
100
Ruth is a resident at Beaver HCRC. Her daughter, Sue, calls to ask you a question about the bill. What is the first thing you should do?
You should confirm that Sue is the responsible party - this is the person that signed the Admission Agreement.
200
True or False - Labs can be on private pay statements if a resident is full private pay
False! Labs should never be on a private pay statement!
200
Sally was a Medicaid recipient at Meadowview. She CTB and now has a credit on her account of $3,800.00. There is not an open estate, her spouse CTB in 1997, she has 3 surviving children and no outstanding funeral expenses. Who does the refund go back to?
Medicaid Estate Recovery - If there is no open estate, no surviving spouse and no outstanding funeral expenses, and the resident was a Medicaid Recipient, any credit over $3,400.00 needs refunded to Medicaid Estate Recovery per their guidelines. It does not get split between the children.
200
Margaret is a resident of Jefferson Hills Manor. Her gross income is $500.00. Her spouse gets a spousal allowance of $150.00. The typical Medicare premium is $104.90. Margaret is considered a buy in. What is Margaret's patient liability?
$305.00/month ; $500.00 gross income - $45.00 PNA - $150.00 spousal allowance = $305.00. Buy in resident's do not get the Medicare premium deduction.
200
Hester had a beauty/barber service for $15.00. The facility batched it to Medicaid as the resident's "free" service for the month. How much do we get reimbursed from Medicaid?
Nothing! We get paid a flat rate from Medicaid.
200
Your billing statement says "Room and Board" with a rate of $161.00 per day. What is most likely wrong with the account?
The payer tree is set up incorrectly - it does not have a coinsurance line, therefore defaults to Private pay room/board when it should be Medicare coinsurance
300
What is the cash clearing account G/L?
1115-000
300
An attorney calls you and explains they are representing a resident's family member at a facility. They would like copies of the statements and the admission agreement. What two things does the attorney need to provide us?
A release form from the family member giving us permission to provide them the information in addition to a formal, written request with specifics of what they need.
300
True or False - Medicaid allows deductions for Guardianship Fees.
True! Up to $100.00/month
300
True or False - Michaela is really good at spelling insurnance
Obviously false- I misspell it in everything I type and spelled it wrong at least 10 times while making this majestic game
400
What are you checking for when you review the Medicaid Pending revenue journal?
Ensuring that all ancillaries contract off
400
Name the time limits to filing estate claims in OH, PA, and WV
OH - 6 months from the DOD PA - typically as long as the estate is open wv - 90 days from the date of public anouncement
400
If a resident has a Medicaid HMO, how many days must we bill the HMO before billing traditional Medicaid?
30 days
500
Name two things that are not charged in advance
Ancillaries, Medicare coinsurance, managed care copays
500
What was the Medicare coinsurance amount in 2015?
$157.50
500
How long do home maintenance allowances end? How long do spousal allowances end?
Home Maintenance Allowance - up to 6 months; Spousal Allowance - as long as the spouse is living in the community
500
Joe was admitted to Mulberry on 10/1/2016 as private pay. The facility applied for Medicaid effective 10/15/2016. He was approved for this date without a penalty period. Joe does not have the money to pay for the room/board from 10/1/2016-10/14/2016. Can we OME his account?
Yes!
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