Reimbursement Policy
True or False: The CPT code 88150 is a payable code
True
This system tool is used to confirm the IPPS pricing methodology
Cortex
What is the amount of unit(s) a provider can bill that automatically tell us an MUE denial is wrong?
1
What do you have to be careful about when filling out the survey for disputes?
Grammar and spelling
When handling global edits, can two lines on the same claim deny for ^GLOBA?
Yes
This is the Place of Service code that represents Telemedicine
02
What does an escalator do to pricing?
Adds a yearly percentage to the total pricing of the claim
For PTP and GLOBA denials, how do you read Periscope?
Right to left
What does "adjust to" indicate in Nuc?
You are not on the most recently adjusted claim
What two ways can you search in the Problem Solving Sheet?
Fee schedule and the Contract Link
True or False: The CPT code 99253 is a payable code
True
What is the difference between first and second dollar carevouts?
First dollar uses ALL money
Second dollar uses the difference in the billed amount and the threshold
What is the ASA base value of 01842?
6
True of False: Joiners, NDA, and Credentialing documents are types of contracts?
False
What attachment can overturn a ^SVCNC denial?
PC
The RVU code "M" stands for which kind of billable codes?
Measurement and Reporting codes
How does priority ranking work?
Only the highest ranked service billed on the claim will be paid
BONUS: With the exception of carveouts
What is the DRG weight for a claim billed on 10/02/2020 with DRG 003?
18.9912
When would you use the Mistriaged label?
NEVER, should be mistriaged
What bucket would you move an %ELDOS hold to?
Eligibility
When a patient is moved from an emergency room setting to an inpatient setting in an unaffiliated facility, what is the reduction amount that Oscar will apply to the allowed amount?
50% - Transfers section
What is the formula for anesthesia pricing?
(ASA Base + (MIN / 15)) * Contracted rate
What is Oscar fee schedule?
CMS gap rates
If an MUE needs to be escalated what do you add to the ticket?
MUEDTcrt label
What is the difference between soft and hard denials?
Soft - documentation pends
Hard - strict (non-paying) denials