CUs
This adjustment code is used when a CU claim generates past timely filling and we have no justification to bill past timely.
What is UNTCOVINF?
This is the length of the onset period in days.
What is 120 days?
These are the 4 IPOP codes we receive
What is C729A, C729B, C729C, C729i
What is Coordination of Benefits
NCD stands for
What is National Coverage Determination
A "1" in the data indicator on page 5 of CWF combined with a previous payer being Medicaid or Medicaid Assigned indicates this.
What is a state buy-in involvement?
All claims in the MCONSET GL are billed to Medicare with a BPU in these months.
What is month 5 and month 10?
What IPOP TX denial code requires an immediate adjustment once Snappy/CWOW verification is made?
What is C729B?
Only this MSP type allows for conditional billing.
What is MSP type B?
This often-forgotten adjustment code is to be used if a claim was received by Medicare timely but was not notated by an MPP TM before becoming untimely.
What is UNTCOLFU?
When our only response to a claim is this and an adjustment is being taken screenshots need to be sent to imaging.
What is an RTP?
The 5 places you can find re-entitlement or transplant information
What is CMS 2728 Form, RNG clinical tab, calling Medicare, DDE CWF, Noridian Portal
This number of contacts to a facility is required for verifying if a TX was truly provided
What is one?
A denial is received due to a MSP overlap. Checking the Noridian Portal shows no MSP overlap.
Rebilling with Noridian requires this.
What is adding to the 727 SS with D1/CC?
A TX rate discrepancy is identified to be caused by a different weight value between PPS attributes and DDE.
The claim is timely.
This action should be taken.
What is take a CA Manual?
Claim with DOS 01/01/2023 - 01/25/2023 denied for 39011 - Past TF
Coverage updated from Managed Medicaid with a gen date of 04/05/2023.
Medicare provided a DOA of 01/09/2021
There is a Medicaid retraction from 01/18/2024.
A Reggie note dated 03/05/2021 indicates that Medicare should be primary.
This action should be taken.
What is to take a Bad Debt Adjustment?
Medicare has a FDODE of 02/01/2021 which matches the 2728.
VIA/RNG shows a FDODE of 04/15/2023.
There are TXs in MOS 03/2023 with an AKI DX code.
The claim is 13+.
This action should be taken.
What is take a CA Manual?
This is the turnaround time for a 13+ IPOP facility contact with a home modality TX.
What is 24 hours?
A DOD denial is received.
VIA and Medicare have a matching DOD of 02/23/2020.
There are no TXs booked after 02/14/2020.
This is likely why the DOD denial was received.
What is services after the DOD?
A claim RTPs for 31806 - Missing HGB.
In VIA HGB is missing.
The claim is timely.
This action should be taken
What is an escalation to Casey?
Today you are working a past timely filing CU Claim (DOS 2022) for retroactive Medicare with state buy in; DOA is 08/02/2023, per Reggie RRS found active Medicare 08/18/23 and updated coverage, Medicaid recouped payment on 11/19/2023. Do you have justification to collect?
What is Yes -- based on the Medicaid Recoup date being within last 6 months.
Medicare has a FDODE of 03/03/2023 which matches VIA/RNG and the 2728, but claims were only paid with onset until 06/28/2023. This is the likely root cause.
Tiburones calc may be used as a resource
What is the CWF FDODE discrepancy issue?
A C729C TX denial code is received
The TX modality is HD
The facility confirmed TX was truly provided
This action should be taken
What is add to the ACF tab?
A MSP denial is received for a MSP type G (Disability overlap) effective 01/05/2023.
The patient's FDODE is 06/07/2023.
Reggie does not indicate any MSP information.
This action should be taken.
VIA is booking 30 TX and Medicare paid for 29 due to 1 TX denied for C729C.
There is a remaining balance in the Tiburones Calc due to a TX rate discrepancy.
There are no denied labs or drugs. The only cause of the discrepancy is due to non-covered TXs affecting outlier.
This adjustment code should be used for TX rate discrepancy.
What is a CA Manual?