CMS Pricer
The Medicare Provider Transaction Number is known as the...
This is the purpose of the Adjustment Override Function...
What is "Reduce Contractual Adjustment Requests"?
This link in the Cash Rep Portal is used to upload your PMF documentation for review...
What is "Cash Review"?
This is the PIC for a recoupment request...
What is "RCOU"?
This is used as a guide to ensure we have notated all necessary information showing we have exhausted all efforts to receive payment on a claim...
What is "Appeal Checklist"?
Medicare updates CMG annually during this month...
What is "October"?
What is "Insurance Tab & Millennium"?
This must be attached on the Cash Review link with the PMF...
What is "Back Up Documentation"?
This PIC is used when we submit a refund and the insurance also recoups...
What is "RFRC"?
This person is responsible for confirming if the appeal is necessary and all documentation presented is correct...
What is "Sr. ARA"?
The CMS Web Pricer is a tool that is used to estimate payments for Medicare and commercial insurance plans that are to pay according to these guidelines...
What is "Medicare Guidelines"?
This is the Millennium accommodation selection that is equivalent to accommodation code 36 in Patcom...
What is "Private Level 2"?
If a request was not completed by Cash and it was valid, we would escalate an email to leadership who will review with this person...
What is "Cash Manager"?
This is the number of hours Medicare allows a patient to be readmitted to an inpatient facility after discharge from an Encompass Health facility...
What is "72"?
When placing an appeals request we use this activity code and this status code...
What is "430 & 515"?
A 2-digit code is placed in this field to indicate how the patient was discharged...
What is "Patient Status"?
This is the next action step when an accommodation code needs to be updated...
What is "Escalate to Leadership (PAM or BOM)"?
These types of payment postings do not require a PMF...
What is "Manual Postings (Posted in IPscan)"?
An overpayment recovery letter is received stating the claim was over paid due to the patient being transferred to another facility. We would need to verify these two key details prior to calling the insurance...
What is "Discharge Disposition & UB04"?
What is "Once the payment is received"?
If the billed DOS are 9/12/2023 - 10/03/2023, then the pricer will return the rate for this year...
What is "2024"?
This is the next action step if an override has previously been requested and did not update...
What is "Place a manual contractual adjustment so the true balance is correct"?
These are the 3 reasons for requesting a PMF...
What is "Auto-posted payments no belonging to patient account (interest/MR), Auto-posted payments for patient accounts (misread T-codes/account #), and Transferring patient payments"?
This is requested when the offset is unknown...
What is "Negative Balance Transfer Sheet"?
If a Representative advises of an appeal denial, this is what we request to be sent if it hasn't already...
What is "Determination Letter"?