faq billing questions · managed care not identifying coverage missing authorization level of care...
TRANSCRIPT
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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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