SSMS Tables
In what SSMS table do you find CPT information
Trakker.AccountCPT
What type of data does Cloudmed receive?
Pre-Edit Data
Drug Charges refers to what?
Charge amount on UB-04
A patient who stays in the hospital for an expected stay of “one midnight” is considered to be receiving what services?
Observation services
Admit is equal to what on a Newborn claim?
Birth
In what SSMS table do you find procedure code information?
Trakker.AccountProc
What type of information can we receive from clients that shows us denials for Post-Edit data?
837 Data
True or False: Depending on the contract, charges that fall into the exclusions bucket can be removed from Outlier consideration
True
Observation hours are typically billed on what type of claim
OP Claims
What is a common payment method we typically see with delivery claims?
Per Diem
In what SSMS table do you find HCPCS information?
Trakker.TtemizedBill
Most Pre/Post-Edit risk must be confirmed by what?
Project Team via client systems
Most contracts have a ___ before the exclusion takes affect
A threshold
True or False: Surgeries are performed while in the observation room
False
What revenue codes are associated with NICU days?
171-174
In what SSMS table do you find the primary diagnosis code on an account in?
Trakker.AccountDiag
Name two examples of Pre vs Post edit changes
HCD RevCode changes, Implant RevCode changes, Modifiers adding, Charges updated
Where can we obtain invoice cost?
Medical Records or Patient File, Asking the team to reach out to the client, contact implant vendor/manufacturer directly
Insurance companies typically put a ___ for how long a patient can be considered in observation for
Time limit/Specified Timeframe
What are the APR-DRGs associated with newborn claims?
580-640
In what SSMS table can you find the correct unit billing for High Cost Drugs?
GlobalReference.Pharma.DrugAdministration
To identify improper coding that may lead to excessive or incorrect reimbursement is why ___ are done.
Bill Edits
Name 2 ways Drug Cost is defined in Medicaid Manuals
Average Wholesale Price (AWP), ASP, WAC
Provide two examples for OP service that should take precedence over observation when billed together
ER and Treatment Room
What 2 ways can birth weight be reported on Newborn Claims?
Condition Code or Diagnosis codes