Alphabet Soup
Where do I live in EPIC?
Rules and Regs
The Private Side
What status am I?
100
MA
What is Medicare Advantage
100
Order history
Where do I find the status orders?
100
2 midnight
What is the number of days required for Medicare inpatient stay
100
BCBS UHC CIGNA
What are examples of commercial health plans?
100
Scheduled CV Surgery
What is inpatient?
200
ABN
What is advanced beneficiary notice
200
Utilization Review
What is the place where MCG reviews are found
200
inpatient only surgery left AMA expired
What are examples of exceptions to the 2MN rule
200
Over 48 hours
What is the length of time plans will allow for observation stays?
200
Chest Pain -normal labs/EKG
What is observation?
300
MOON
What is Medicare Outpatient Observation Notice
300
Payer decision
What is Utilization Management flow sheet in the IP CM and SW Navigator
300
Condition Code 44
What is the rule for changing a Medicare inpatient to observation.
300
Peer to Peer
What is the process to appeal a denial while the patient is still in house?
300
Post op hernia repair
What is extended recovery?
400
IMM
What is the Important Message from Medicare
400
Notes from Access CM
What is the HAR note
400
the 2 midnight presumption
What is the rule that allows providers to order inpatient on admission if the type of care needed usually spans 2 midnights.
400
Humana MA plan BCBS state UHC MA Plan
What are plans that have on-site reviewers at NHRMC?
400
Elder brought to ED because family going OOT.
What is outpatient needs a bed?
500
HINN
What is Hospital Issued Notice of Non-Coverage
500
the authorization number
What is Auth/Cert
500
The 2 midnight benchmark
What is met if the provider has already spent one midnight for hospital care and is expected to require another.
500
Denials
What is the process commercial payers use to try to avoid paying for care rendered?
500
Drug overdose sent to ICU from ED
What is possible observation?
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