Kick Off
This Kick code is used to remove holds from a claim and send a claim out for processing
What is DRPBILLING?
This Modifier is added to an E/M visit to signify a Significant, separately identifiable service by the same physician or other qualified health care professional on the same day of the procedure or other service
What is 25 modifier?
This is the Dollar amount Threshold for claims that need to be added to the adjustment spreadsheet
What is $500 and above?
These are the two most common Governmental Payors
If a patient has multiple insurances, this determines which payor is primary
What is Coordination of Benefits?
This Kick Code is used when the provider is not yet participating with an insurance, but is in process.
What is CREDENTIAL?
This Modifier is added to a procedure code to signify that it is a distinct procedural service billed on the same day as another service
What is Modifier 59?
This is the adjustment reason used when a claim has not received an authorization
what is NO AUTH?
When a Medicare claim has been paid but a coding change has been made, this must be done to send a correction
What is a reopening?
For Most payors, this balance is owed at the beginning of the year and is often not covered by secondary insurances
What is the Deductible?
This Kick code is used when a claim needs to be moved to the Billing Coordinator worklist
what is PROVHOLD?
What is Modifier TC?
This is the dollar amount Threshold for adjustments that must be sent to the market to approve
What is $1000 and above?
When a Medicaid patient has this type of plan, they cannot receive a bill for services
what is QMB?
this is a flat fee that is owed by the patient each time you visit the doctor or fill a prescription
What is a copay?
This Kick code can be used when you have opened a case with athena or placed a claim on the adjustment sheet
What is CIP?
When a claim does not meet LCD Guidelines, What is usually the issue?
This is the kick code you add to a claim when it is pending adjustment approval
What is CIP?
These two governmental payers are for Members of Active military or Veterans and cannot be billed with Medicare
What are Tricare and VA?
this is a document signed by the authorizing person owner, allowing the recipient or holder of the information to disclose or use the information through the consent of the owner. (Usually used by a third party to request records or a billing statement)
What is a Release of Information?
This Kick code is used when a call is made to the payer and the claim is being sent back for review
What is REPROCESS?
On a PBB Claim, this condition code is used to Signify that multiple distinct facility claims were billed on the same day at the same facility.
What is Condition Code G0?
What must you do to a claim that has been pended to yourself for medical records before adding the claim to the adjustment sheet or appealing?
What is follow up with your Team Lead via email on the request?
This type of visit can only be performed once a year with Medicare patients and will deny for frequency if the last visit was under a year ago
What is a Medicare Wellness Visit?
This was a federal law established in 1996 that requires the creation of national standards to protect sensitive patient health information from being disclosed.
what is HIPAA?