Beacon Jeopardy - Commercial

Claim Detail

100

When working on AR follow-up, which of the following should be prioritized?

A. Patient satisfaction surveys

B. Claims paid in full 

C. Recently submitted claims under 10 days old 

D. Claims over 90 days old with high dollar balances

D. Claims over 90 days old with high dollar balances

200

Scenario:

A partial payment received matches the expected reimbursement. What do you do next?

A. Bill the pt the remaining balance

B. F/U with the payor for the remaining balance

C. Adjust remaining balance

D. Send to the Beacon biller...they love that

C. Adjust remaining balance (if the expected reimbursement is met, adjust regardless of the denial.)

300

Scenario:

If a claim denies for no auth and a retro auth is not possible. How do you proceed?

A. Adjust with code 3140 and apply action code WOFTF

B. Adjust with code 3140 and apply action code WONOA

C. Call the payor and ask them to pay anyway

D. Note the account that "retro auth not possible. Following up in 30-45 days"

B. Adjust with code 3140 and apply action code WONOA

400

BONUS GAME - 

1. WORDLE

2. Pick another Question :)

Congrats!

500

What does FFS mean in the context of healthcare billing?

A. Fast-Filing System — Accelerated claim submission 

B. Fast Food Style — Summary of charges and payments (but quick and delicious)

C. Fee-for-Service — Payment model where services are billed individually

D. Federal Funding Schedule — Government payment calendar

C. Fee-for-Service — Payment model where services are billed individually

Patient detail

100

TFL to bill the PT is _____.

A. 1 Year from DOS 

B. 1 Year from Denied date 

C. 180 days from DOS

B. 1 Year from Denied date

200

If ANTHEM partially paid the claim & partially denied the claim as Level of care. Per WORKFLOW found it is already assigned to ROBOT. What is the next action?

A. Move the claim to non-workable

B. Appeal the claim with MR 

C. Send the claim to coding team

D. The robot is all knowing...they can handle it

A. Move the claim to non-workable

300

If a claim is denied for bone density CPTs (e.g., 77080) due to mutually exclusive procedures being performed on the same day or in the same setting, what is the next action?

A. Move the claim to coders 

B. Resubmit the claim 

C. Appeal the claim with Bone Density record

D. Wait...the problem will resolve itself 

C. Appeal the claim with Bone Density record

400

What is a valid Place of Service (POS) code for an office visit?

A. 22

B. 11 

C. 21 

D. 24

B. 11

500

Which modifier is used to indicate that a procedure or service was altered but not changed in its definition or code?

A. Modifier 25 

B. Modifier 59 

C. Modifier 22 

D. Modifier 51

B. Modifier 59. 

ACTN Codes

100

What is the Cerner action code for Sub status code

A - UNTIMELY FILING ADJUSTMENT -AUTHORIZATION ADJUSTMENT

WONOA

200

What is the Cerner action code for Sub status code

B - REQUESTING TO SUBMIT MEDICAL RECORDS THRU MAIL

B - REQUESTING TO SUBMIT MEDICAL RECORDS THRU MAIL

300

What is the Cerner action code for Sub status code

G - NDC REVIEW

NDCM

400

What is the Cerner action code for Sub status code

F - PROVIDER ISSUE

NOTENR

500

What is the Cerner action code for Sub status code

D - BILLED TO PATIENT

BALPT

Acronyms!

100

ABN

Advance Beneficiary Notice

200

DME

Durable Medical Equipment

300

GHP

Group Health Plan

400

MSP

Medicare Secondary Payer

500

HCPCS

Healthcare Common Procedure Coding System