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

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FAQ BILLING QUESTIONS

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

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FAQ BILLING

QUESTIONS

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MISSOURI MEDICAID

Incorrect Payment

Hospice Medicaid

Not Approved

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MISSOURI MEDICAID

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MEDICARE A

Hospital Stay Issues

Sequential Billing

HMO,MSP & Hospice Overlaps

Missing/Invalid Information

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MEDICARE A

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SELF PAY

INVALID CHARGES

MISAPPLIED PYMTS

NOT HAVING A COLLECTIONS POLICY

UN INFORMED RESIDENTS

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MEDICARE B

Missing/Invalid Modifiers

G Codes

Occurrence Codes

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MEDICARE B

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MANAGED CARE

Not Identifying Coverage

Missing Authorization

Level of Care VS.

PPS

HospiceUnbilled

Coinsurance

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MANAGED CARE

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COINSURANCE

Dual Eligible

Crossover VS. Non Crossover

Supplemental (Medi-Gap) VS. INSURANCE

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COINSURANCE

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COINSURANCE

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COMMON DDE ERRORS

Verbatim Remarks

Identifying ADR

Status

Adding Modifiers

Rejected Claims

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COMMON DDE ERRORS

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COMMON DDE ERRORS

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COMMON DDE ERRORS

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COMMON DDE ERRORS

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COMMON DDE ERRORS

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COMMON DDE ERRORS

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COMMON DDE ERRORS

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COMMON KNOWLEDGE GAPS

Coverage of PPS Assessments

Early-Late-Missed Assessments

Compliance Claims

Leave of Absence

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FOLLOW UP TIPS

TechnologyDocumenting

Efforts

Consistent Aging

Review

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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

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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

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Let’s Continue this Conversation!

Julie Bilyeu| [email protected]

@Juliebilyeuhuff

Jennifer Barboa| [email protected]

@JenniferBarboa

Follow us on LinkedIn or Twitter or see information at the Link!

www.bkd.com/thelink

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FirstCare Select HMO Network Gold Coinsurance ......Individual Schedule of Copayments FirstCare Select HMO Network Gold Coinsurance 26539TX0140001-00/01 GHI18D01/GHI18M01 SOCINDCC2018

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Estimating Unbilled Revenues

Estimating Unbilled Revenues

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Komplexe Projektabrechnung und –buchung mit Oracle ... · PDF file(Rel. R11 to R12) • Post-Production ... Unbilled Receivables / Unearned Revenue Receivables / Unbilled Receivables

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Summary of Benefits and Coverage: What this Plan Covers ... · Specialist visit 0% coinsurance 50% coinsurance --none-- ... including buying individual insurance coverage through

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Roundtable -Unbilled Revenue - Alaska Power Associationalaskapower.org/wp-content/uploads/2015/03/MEA-Unbilled...MEA Method -Unbilled Revenue per Class Determine % of net revenues

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Understanding and Explaining the Mysteries of Coinsurance

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Summary of Benefits and Coverage (SBC)€¦ · Urgent care 30% coinsurance. 30% coinsurance. Covered at Tier 2 cost shares. Your costs for urgent care are based on care received at

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Summary of Benefits and Coverage · 2020. 10. 1. · or clinic Primary care visit to treat an injury or illness 0% coinsurance deductible. does not apply for 1st 3 visits 50% coinsurance

Summary of Benefits and Coverage · 2020. 10. 1. · or clinic Primary care visit to treat an injury or illness 0% coinsurance deductible. does not apply for 1st 3 visits 50% coinsurance

Summary of Benefits and Coverage: What this Covers … · Skilled nursing care Not Applicable 20% coinsurance 50% coinsurance ... Please see your plan document.) Abortion Chiropractic

Summary of Benefits and Coverage: What this Covers … · Skilled nursing care Not Applicable 20% coinsurance 50% coinsurance ... Please see your plan document.) Abortion Chiropractic

Extra Benefits...Diagnostic services: $0 copay Restorative services: 20% Coinsurance Periodontics: 20% Coinsurance Extractions: 20% Coinsurance There is a benefit deductible of $35

Extra Benefits...Diagnostic services: $0 copay Restorative services: 20% Coinsurance Periodontics: 20% Coinsurance Extractions: 20% Coinsurance There is a benefit deductible of $35

Q Series Coinsurance Patient Charge Schedule · Plan effective 07/01/13 Page 3 CIGNA DENTAL CARE – PATIENT CHARGE SCHEDULE Series Coinsurance (Part 1: Pages 1–33/Part 2: Pages

Q Series Coinsurance Patient Charge Schedule · Plan effective 07/01/13 Page 3 CIGNA DENTAL CARE – PATIENT CHARGE SCHEDULE Series Coinsurance (Part 1: Pages 1–33/Part 2: Pages

Blue Care Elect Preferred 90 Copay (PPO)...If you need immediate medical attention Urgent care $20 / visit 20% coinsurance Deductible applies first for out-of-network Facility fee

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*Specialty Pharmacy - GlobalHealth · PDF file5 Benefit Description You Pay Checkup No Copayment Basic Dental 30% Coinsurance Major Dental 50% Coinsurance Orthodontia 50% Coinsurance

*Specialty Pharmacy - GlobalHealth · PDF file5 Benefit Description You Pay Checkup No Copayment Basic Dental 30% Coinsurance Major Dental 50% Coinsurance Orthodontia 50% Coinsurance

Health Care Coverage You Need. A Company You Know. › ehealthinsurance › ...Words to Know Benefits – The health care items or services covered under a health insurance plan. Coinsurance

Health Care Coverage You Need. A Company You Know. › ehealthinsurance › ...Words to Know Benefits – The health care items or services covered under a health insurance plan. Coinsurance

Vilhauer Enterprises...(MRI, MRA, Pet Scans, CT Scans, etc.) 30% coinsurance, after deductible 25% coinsurance, Hospital Services 30% coinsurance, after deductible 25% coinsurance,

Vilhauer Enterprises...(MRI, MRA, Pet Scans, CT Scans, etc.) 30% coinsurance, after deductible 25% coinsurance, Hospital Services 30% coinsurance, after deductible 25% coinsurance,

Summary of Benefits and Coverage: What this ... - Home, Home · ... or to get a copy of the complete terms ... health needs Home health care 10% coinsurance 30% coinsurance ... (a

Summary of Benefits and Coverage: What this ... - Home, Home · ... or to get a copy of the complete terms ... health needs Home health care 10% coinsurance 30% coinsurance ... (a

A lower-cost PPO plan that drives employee engagement · Level 1 – Copayments for most primary care office visits.1,4 Level 2 – Rich coinsurance for acute care like admitted hospital

A lower-cost PPO plan that drives employee engagement · Level 1 – Copayments for most primary care office visits.1,4 Level 2 – Rich coinsurance for acute care like admitted hospital

Summary of Benefits and Coverage - University of Iowa of... · is available at m/prescriptions. Tier 1 0% coinsurance 0% coinsurance 0% coinsurance Drugs listed on Wellmark's Blue

Summary of Benefits and Coverage - University of Iowa of... · is available at m/prescriptions. Tier 1 0% coinsurance 0% coinsurance 0% coinsurance Drugs listed on Wellmark's Blue