FAQ BILLING QUESTIONS · MANAGED CARE Not Identifying Coverage Missing Authorization Level of Care...

FAQ BILLING

QUESTIONS

MISSOURI MEDICAID

Incorrect Payment

Hospice Medicaid

Not Approved

MISSOURI MEDICAID

MEDICARE A

Hospital Stay Issues

Sequential Billing

HMO,MSP & Hospice Overlaps

Missing/Invalid Information

MEDICARE A

SELF PAY

INVALID CHARGES

MISAPPLIED PYMTS

NOT HAVING A COLLECTIONS POLICY

UN INFORMED RESIDENTS

MEDICARE B

Missing/Invalid Modifiers

G Codes

Occurrence Codes

MEDICARE B

MANAGED CARE

Not Identifying Coverage

Missing Authorization

Level of Care VS.

HospiceUnbilled

Coinsurance

MANAGED CARE

COINSURANCE

Dual Eligible

Crossover VS. Non Crossover

Supplemental (Medi-Gap) VS. INSURANCE

COINSURANCE

COMMON DDE ERRORS

Verbatim Remarks

Identifying ADR

Status

Adding Modifiers

Rejected Claims

COMMON DDE ERRORS

COMMON KNOWLEDGE GAPS

Coverage of PPS Assessments

Early-Late-Missed Assessments

Compliance Claims

Leave of Absence

FOLLOW UP TIPS

TechnologyDocumenting

Efforts

Consistent Aging

Review

RESOURCES

› CMS CLAIMS PROCESSING MANUAL(S)

› https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c06.pdf

› https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c05.pdf

› CMS RAI MANUAL

› https://downloads.cms.gov/files/1-MDS-30-RAI-Manual-v115R-October-1-2017-R.pdf

RESOURCES

› CMS BENEFIT POLICY MANUAL

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c08.pdf

› BKD RATES

https://www.bkd.com/industries/health-care/long-term-care/rug-database.html

› SUBSCRIBE TO BKD THOUGHTWARE

› https://pages.bkd.com/Subscription-Management_AG-Subscribe.html

Let’s Continue this Conversation!

Julie Bilyeu| jbilyeu@bkd.com

@Juliebilyeuhuff

Jennifer Barboa| jbarboa@bkd.com

@JenniferBarboa

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FAQ BILLING QUESTIONS · MANAGED CARE Not Identifying Coverage Missing Authorization Level of Care...

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Transcript of FAQ BILLING QUESTIONS · MANAGED CARE Not Identifying Coverage Missing Authorization Level of Care...

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