Which of the following is an element of the charge master?
For each service, the chargemaster includes the following components: Item number that is assigned by the facility and unique to one service line item. Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) code.
When Should patient invoices statements be sent to the patient?
45 days post initial claim. When should patient invoices (statements) be sent to the patient? As soon as the RA is posted and a balance is transferred to the patient’s account.
Which is a true statement about daily deposits?
What is a TRUE statement about daily deposits? Keeping checks and cash in the office for more than a day opens the practice up to liability for the cash and checks. Daily deposits should be made for the mail receipts and personal payment receipts.
What is a lower level of care denial?
Lower Level of Care is a denial that applies when the following occurs: Care provided on an inpatient basis is typically provided on an outpatient basis. Outpatient procedure could have been done in the providers office. Skilled nursing care could have been performed by a home health agency.
Which method is the most common to calculate a fee schedule for physicians?
Most payers determine fee schedules first by establishing relative weights (also referred to as relative value units) for the list of service codes and then by using a dollar conversion factor to establish the fee schedule.
Which is a true statement when submitting electronic claims?
What is a true statement when submitting electronic claims? When an electronic claim is rejected due to an error the provider is notified more quickly than paper claims. What documentation is NOT need for an audit? Explanation of benefits.
What does the NCCI file indicate?
Rationale: The NCCI file is a Medicare file that indicates specific CPT code pairs that can be reported on the same day for the same beneficiary by the same provider.
What does it mean to scrub a claim?
The term “scrubbing” refers to an intricate cleaning of a claim prior to submission. Over the past 10 years, automated claims editing has been developed which helps to validate that a claim is appropriate and accurate for submission. There are two components in scrubbing claims.
What is the primary reason for filing claims electronically versus using paper claims?
Electronic claims have fewer errors than paper claims. After the claim is submitted, the explanation of benefits states there is no payment due to deductible not met.
In what format are healthcare claims sent?
The 837P is the standard format used by health care professionals and suppliers to transmit health care claims electronically. The Form CMS-1500 is the standard claim form to bill MACs when a paper claim is allowed. The ANSI X12N 837P (Professional) Version 5010A1 is the current electronic claim version.
How do you detect Downcoding?
To detect downcoding errors, you must be familiar with the fee schedule and compare that to the amount mentioned on the EOB form.
What are the effects of Downcoding?
Usually, downcoding leads to a reduction in the amount of claim. These errors in coding result in massive losses of between $180 and $320 a day. Recently, Medicare revealed that, due to downcoding, healthcare providers have lost up to $320 million.
What is the reason rule?
The Rule of reason is a legal approach by competition authorities or the courts where an attempt is made to evaluate the pro-competitive features of a restrictive business practice against its anticompetitive effects in order to decide whether or not the practice should be prohibited.
What does unbundling mean?
fragmentation
What is an unbundling modifier?
Modifier 59 Distinct procedural service is an “unbundling modifier.” When properly applied, it allows you to separately report—and to be reimbursed for—two or more procedures that normally would not be billed or paid independently during the same provider/patient encounter.
Are unbundling codes illegal?
Upcoding & Unbundling are considered to be unethical billing practices. The Centers for Medicare & Medicaid Services (CMS) says that “[m]isusing codes on a claim, such as upcoding or unbundling codes” are unethical billing practices.
What is bundling unbundling?
What Is ‘Bundling and Unbundling’? Bundling means repurposing value that you already created to create even more value by combining multiple small offers into one large offer. Unbundling is the opposite of bundling, it means splitting an offer into multiple smaller offers.
What is an example of bundling?
Bundling is a marketing tactic that involves offering two or more goods or services as a package deal for a discounted price. Examples of bundling are as widespread as McDonald’s value meals and automobiles with features such as air conditioning, sunroofs, and geographical systems.
What is claim bundling?
As you’re probably aware, claims are “bundled” when a payer refuses to pay for two separate services a practice has billed. Instead, it groups, or bundles, the two charges and pays only one, smaller fee.
What does unbundling of life insurance products refer to?
Unbundling of life insurance products refers to separation of the protection and savings element. A unbundled life insurance policy contains a savings and investment component that the policyholder can use during his or her lifetime or pass on to beneficiaries.