BAD DEBT
This is the denial term used by secondary payers when the primary payer's payment meets or exceeds the amount that the secondary payer would have paid if they had been primary
What is "Max Allowed"?
This is the balance necessary to move forward with Attorney Placement...
What is "$5,000"
This is the first step we would make if we received an underpayment that matches the previous years rate for an insurance.
What is contacting the payer and requesting a reprocessing?
This type of coverage, which typically exhausts benefits during a patient's acute treatment, must always be billed as primary if are a responsible party on an encounter.
What is auto insurance?
These are the types of plans that do not qualify for Medicare Cost Reporting.
What are "Medicare Advantage Plans"?
This is the Coded comment category used for an Attorney Placement request.
What is Attorney?
This is the next step we would take if a payer denies due to missing CMG correctly as our claim was billed without CMG added.
What is to request a rebill with CMG added?
This state funded payer which is reviewed by a BSO specialty team, may appear as primary or secondary, but must always be the payer of last resort.
What is Medicaid?
This T-Code is used if a patient is QMB and does not have a secondary insurance to cover the assigned patient responsibility...
What is "W77X"?
This is the main reason or basis we use for requesting an attorney placement?
What is the root cause?
If a reprocessing or corrected claim has been completed but the payer is still denying, although incorrectly, this higher level review would be our next step.
What is an appeal?
This UFC would be selected for level 2 if the primary RP insurance requires an updated form from the patient before they can complete processing of our claim.
What is TPL?
These types of accounts, regardless of the primary payer, do not qualify for cost reporting...
Outpatient
This Level 3 UFC is used when placing an Attorney Placement Request.
What is ATPN?
If we have exhausted our appeal attempts but we do not wish to move with a write-off, this is our only other option for claim reconciliation.
What is attorney placement?
This type of Responsible Party (RP) is a secondary plan type and should be selected when the balance that remains is patient responsibility as assigned by the primary.
What is a Medicare supplement plan?
This T-code is used if a patient has a Medicare Advantage plan and secondary commercial plan denies the patient responsibility due to max allowed.
What is W774 T-Code?
This is the estimated attorney fee for an account with a balance of $37,000 when we have exhausted all appeal efforts and the insurance is upholding a decision that they have paid per contract.
What is $7,400?
If an insurance denies our claim as non-covered due to having termed prior to our dates of service, this would be our next step in our review.
What is a review of eligibility?
When we have three incidents of the exact issues with the same insurance we may escalate the account as possibly part of this trend.
What is a Known Payer Issue?