Adjustments
What is the difference between X303 & X403?
What is pre and post payment?
What do write-off T-code start with?
What is W?
FC TN, non-contracted primary insurance denied due to untimely filing. DOS 08/26/2023 - 09/10/2023
***B1 W331 $126.89 CY09/11/2023***
What is incorrect discharge day?
This is the T-code used if primary Medicare advantage insurance assigned patient responsibility and Medicaid denies for Max allowed.
What is W211?
How many total asterisks are needed for one adjustment request?
What is 6?
Write-offs are used to report what?
What is Loss in Revenue?
Aetna Medicaid paid correctly per contract minus two days. The balance on the account is $1190.00 However it should be $1200.00. DOS 04/20/2023 - 05/01/2023
***B1 X403 $(10.00) CY05/01/2023***
What is no error?
This T-code is used when writing off balance due to timely filing for TO FC?
What is W331?
Adjustments are used to reflect the difference between what two things?
Billed Charges and Payer's Contractual Obligation
NMCR Primary insurance paid correctly and applied $1200 patient responsibility. The balance is in bucket 2 and Medicaid denied for max allowed. DOS 04/20/2024 - 05/01/2024. How would you request the adjustment?
What is ***B2 W211 $1,200.00 CY05/01/2024***
Facility did not obtain authorization from the primary insurance. FC is TT. Balance on account is $911.00
***B1 W441 $(911.00) CY08/28/24***
Two-digit year & Brackets
Inpatient Aetna Medicaid account. A denial has been received for no continued authorization and a peer to peer was performed.
What t-code and status code would be used?
What is W451 and 500 status?
Typically, adjustments are made based off of this insurance?
What is Primary Insurance?
Write-offs due to no continued authorization are statused to?
What is Status Code 500?
OP Primary insurance is BC Medicaid. BC paid all line except for hot/cold packs.
***B1 W211 $75.00 CY01/01/2024***
What is T-code W211? This would be a true up and not a write-off. Should have used X403 instead.
This is the T-Code used to submit a write-off when the payer is denying due to ROPA
What is W700
Inpatient remaining balance on account of $386.09. FC is TT. Per review, Insurance paid correctly. Patient was discharged on 07/07/2024. What would the request adjustment be?
***B1 X403 $386.09 CY07/07/2024***
Late charges of $(150.00) were added to the account after the final bill charges dropped. FC is TT and payer pays per diem. The patient was discharged 01/01/2024 How should the adjustment be requested?
***B1 W221 $(150.00) CY01/01/2024***
IP MCR Advantage paid correctly at 100% CMG and applied patient responsibility of $1632.00. Current balance on the account is $1632.01 & we received a max allowed denial from secondary Medicaid. DOS 11/21/2023 - 11/26/2023.
***B1 X404 $0.01 CY11/26/2023***B1 W211 $1,632.00 CY11/26/2023***
What is incorrect manual adjustment T-Code?
On Medicaid, write-off T-codes are the same no matter if it is an IP account or an OP account. The only time IP/OP changes the T-code is when we submit this type of adjustment, what are those T-codes?
What is a pre or post payment manual adjustment?
IP Post X403 OP Post X404
IP Pre X303 OP Pre X304