Rate Types
This is the reimbursement method where SanStone/BRR receives one set dollar amount per day for qualifying MCA residents.
What is a flat daily rate?
The flat rate for MCA residents per day across all Sanstone/BRR sites.
What is $95.00 per day?
This payer is billed at 65% NC Fee schedule.
What is Humana B?
The report that shows the tracking of services where minutes provided are within a specified threshold of the next billable unit.
The Vice President of Sanstone?
Who is David Fardulis?
RPA, NAVI, and Humana A are all billed using this per unit of treatment time method, at $0.97 each.
What is Per Minute?
The per minutes rate billed for RPA, NAVI, and Humana A.
What is $0.97?
This payer is billed using a 75% NC fee schedule and has MPPR applied.
What is RPB?
This yes/no flag appears on nearly every fee-schedule payer, meaning claims get reduced when multiple procedures are billed the same day.
What is Apply Multiple Procedure Payment Reductions (MPPR) = Yes?
The President of Sanstone.
Who is Jennifer Robinson?
Private Therapy is billed based off of these.
What are CPT codes?
Therapist rate per visit for Optum B.
What is $56.25?
This payer (and it Outpatient counterpart) is billed at 65% of the NC fee schedule - the lowest fee-schedule percentage on the Sanstone contract.
What is Humana B and Outpatient Humana B?
Units per visit target for ST.
What is 1.5?
Splints are reassessed at minimum in this time frame.
Humana B, RPB, MCB, Private Pay, and Workman's Compensation are all billed using this method.
What is Physician Fee Schedule?
Therapist rate per visit for UHB.
What is $45?
These two payer lines are the only ones on the contract with an "Assistant Modifier % to Reduce".
What are MCB (MPPR) and Outpaient MCB (Palmetto) MPPR?
The name of the report used to assess patterns in CPT code billing.
What is CPT Utilization Report.
The fee-schedule state referenced throughout the contract, for region code 1150200.
What is North Carolina?
Humana B, RPB, MCB, Private Pay, and Workman’s Compensation are all billed using this reimbursement method.
What is a per-minute rate?
The percentage of the NC fee schedule (region 1150200) most fee-schedule payers on this contract are paid at.
What is 75%?
The SanStone contract uses multiple reimbursement methodologies rather than one universal rate. Name three.
What is a flat daily rate, per-minute rate, or percentage of fee schedule?
Lead biller from BRR for Sanstone.
Who is Jill Londeree?
Daily Double!!
True or False: The entire Sanstone contract is one flat rate?