WhatgservicegprovidedgtogagMedicaregbeneficiarygingagruralghealthgclinicg(RHC)gisgnotgbillablegasgang
RHCgservices?g-ganswer>>.Inpatientgcare
Whatgaregcollectiongagencygfeesgbasedgon?g-ganswer>>.Agpercentagegofgdollarsgcollected
Whatgcodegindicatesgthegdispositiongofgthegpatientgatgthegconclusiongofgservice?g-
ganswer>>.Patientgdischargegstatusgcode
WhatgdogthegMSPgdisabilitygrulesgrequire?g-
ganswer>>.Thatgthegpatient'sgspouse'sgemployergmustghaveglessgthang20gemployeesgingtheggroupg
healthgplan
whatgorganizationgoriginatedgthegconceptgofginsuringgprepaidghealthgcaregservices?g-
ganswer>>.BluegCrossgandgbluegShield
WhatgareghospitalsgrequiredgtogdogforgMedicaregcreditgbalancegaccounts?g-
ganswer>>.Theygresultginglostgreimbursementgandgadditionalgcostgtogcollect
Whengangunduegdelaygofgpaymentgresultsgfromgagdisputegbetweengthegpatientgandgthegthirdgpart
ygpayer,gwhogisgresponsiblegforgpayment?g-ganswer>>.Patient
Self-
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e?g-ganswer>>.Birthday
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hegpayergandgsomegorgallgproviders?g-ganswer>>.Casegrates
,MedicaregguidelinesgrequiregthatgwhengagtestgisgorderedgforgagLCDgorgNCDgexists,gtheginformatio
ngprovidedgongthegordergmustginclude:g-ganswer>>.AgvalidgCPTgorgHCPCSgcode
Withgadvancesginginternetgsecuritygandgencryption,grevenue-
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ganswer>>.Accessgtheirginformation gandgperformgfunctionsgon-line
WhatgdategisgrequiredgongallgCMSg1500gclaimgforms?g-ganswer>>.onsetgdategofgcurrentgillness
Whatgdoesgschedulinggallowgprovidergstaffgtogdog-
ganswer>>.Reviewgappropriatenessgofgthegservicegrequest
Whatgcodegisgusedgtogreportgthegprovider'sgmostgcommongsemiprivategroomgrate?g-
ganswer>>.Conditiongcode
Regulationsgandgrequirementsgforgcodinggaccountablegcaregorganizations,gwhichgallowsgprovider
sgtogbegingcreatinggthesegorganizations,gweregfinalizedgin:g-ganswer>>.2012
WhatgisgagprimarygresponsibilitygofgthegRecovergAuditgContractor?g-
ganswer>>.TogcorrectlygidentifygpropergpaymentsgforgMedicaregPartgAg&gBgclaims
Howgmustgprovidersghandlegcreditgbalances?g-
ganswer>>.Complygwithgstategstatutesgconcerninggreportinggcreditgbalance
Insurancegverificationgresultsgingwhat?g-
ganswer>>.Thegaccurategidentificationgofgthegpatient'sgeligibilitygandgbenefits
,WhatgformgisgusedgtogbillgMedicaregforgruralghealthgclinics?g-ganswer>>.CMSg1500
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ustgbegcodedgusinggwhat?g-ganswer>>.HCPCSg(HealthcaregCommongProceduregCodinggsystem)
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Whygdoesgthegfinancialgcounselorgneedgpricinggforgservices?g-
ganswer>>.Togcalculategthegpatient'sgfinancialgresponsibility
Whatgtypegofgprovidergbillsgthird-partygpayersgusinggCMSg1500gformg-ganswer>>.Hospital-
basedgmammographygcenters
Howgaregdisputesgwithgnongovernmentalgpayersgresolved?g-
ganswer>>.Appealgconditionsgspecifiedgingthegindividualgpayer'sgcontract
ThegimportantgmessagegfromgMedicaregprovidesgbeneficiariesgwithginformationgconcerninggwhat
?g-ganswer>>.Rightgtogappealgagdischargegdecisiongifgthegpatientgdisagreesgwithgthegservices
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hegSNFgpermittedgtogdo?g-ganswer>>.SubmitginterimgbillsgtogthegMedicaregprogram.
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aftergwhatghappens?g-
ganswer>>.120gdaysgpasses,gbutgthegclaimgthengbegwithdrawngfromgthegliabilitygcarrier
WhatgdatagaregrequiredgtogestablishgagnewgMPIgentry?g-
ganswer>>.Thegpatient'sgfullglegalgname,gdategofgbirth,gandgsex
Whatgshouldgthegprovidergdogifgbothgofgthegpatient'sginsurancegplansgpaygasgprimary?g-
ganswer>>.Determinegthegcorrectgpayergandgnotifygthegincorrectgpayergofgthegprocessinggerror
WhatgdogEMTALAgregulationsgrequiregon-callgphysiciansgtogdo?g-
ganswer>>.Personallygappeargingthegemergencygdepartmentgandgattendgtogthegpatientgwithingagr
easonablegtime
Atgthegendgofgeachgshift,gwhatgmustghappengtogcash,gchecks,gandgcreditgcardgtransactiongdocume
nts?g-ganswer>>.Theygmustgbegbalanced
WhatgwillgcausegagCMSg1500gclaimgtogbegrejected?g-
ganswer>>.Thegprovidergisgbillinggwithgagfuturegdategofgservice
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orgservices?g-ganswer>>.Thegcostgofgthegtest
howgaregHCPCSgcodesgandgthegappropriategmodifiersgused?g-
ganswer>>.Togreportgtheglevelg1,g2,gorg3gcodegthatgcorrectlygdescribesgthegservicegprovided
RHCgservices?g-ganswer>>.Inpatientgcare
Whatgaregcollectiongagencygfeesgbasedgon?g-ganswer>>.Agpercentagegofgdollarsgcollected
Whatgcodegindicatesgthegdispositiongofgthegpatientgatgthegconclusiongofgservice?g-
ganswer>>.Patientgdischargegstatusgcode
WhatgdogthegMSPgdisabilitygrulesgrequire?g-
ganswer>>.Thatgthegpatient'sgspouse'sgemployergmustghaveglessgthang20gemployeesgingtheggroupg
healthgplan
whatgorganizationgoriginatedgthegconceptgofginsuringgprepaidghealthgcaregservices?g-
ganswer>>.BluegCrossgandgbluegShield
WhatgareghospitalsgrequiredgtogdogforgMedicaregcreditgbalancegaccounts?g-
ganswer>>.Theygresultginglostgreimbursementgandgadditionalgcostgtogcollect
Whengangunduegdelaygofgpaymentgresultsgfromgagdisputegbetweengthegpatientgandgthegthirdgpart
ygpayer,gwhogisgresponsiblegforgpayment?g-ganswer>>.Patient
Self-
fundedgbenefitgplansgmaygchoosegtogcoordinategbenefitsgusinggtheggendergrulegorgwhatgothergrul
e?g-ganswer>>.Birthday
Ingwhatgtypegofgpaymentgmethodologygisgaglumpgsumgorgbundledgpaymentgnegotiatedgbetweengt
hegpayergandgsomegorgallgproviders?g-ganswer>>.Casegrates
,MedicaregguidelinesgrequiregthatgwhengagtestgisgorderedgforgagLCDgorgNCDgexists,gtheginformatio
ngprovidedgongthegordergmustginclude:g-ganswer>>.AgvalidgCPTgorgHCPCSgcode
Withgadvancesginginternetgsecuritygandgencryption,grevenue-
cyclegprocessesgaregexpandinggtogallowgpatientsgtogdogwhat?g-
ganswer>>.Accessgtheirginformation gandgperformgfunctionsgon-line
WhatgdategisgrequiredgongallgCMSg1500gclaimgforms?g-ganswer>>.onsetgdategofgcurrentgillness
Whatgdoesgschedulinggallowgprovidergstaffgtogdog-
ganswer>>.Reviewgappropriatenessgofgthegservicegrequest
Whatgcodegisgusedgtogreportgthegprovider'sgmostgcommongsemiprivategroomgrate?g-
ganswer>>.Conditiongcode
Regulationsgandgrequirementsgforgcodinggaccountablegcaregorganizations,gwhichgallowsgprovider
sgtogbegingcreatinggthesegorganizations,gweregfinalizedgin:g-ganswer>>.2012
WhatgisgagprimarygresponsibilitygofgthegRecovergAuditgContractor?g-
ganswer>>.TogcorrectlygidentifygpropergpaymentsgforgMedicaregPartgAg&gBgclaims
Howgmustgprovidersghandlegcreditgbalances?g-
ganswer>>.Complygwithgstategstatutesgconcerninggreportinggcreditgbalance
Insurancegverificationgresultsgingwhat?g-
ganswer>>.Thegaccurategidentificationgofgthegpatient'sgeligibilitygandgbenefits
,WhatgformgisgusedgtogbillgMedicaregforgruralghealthgclinics?g-ganswer>>.CMSg1500
Whatgactivitiesgaregcompletedgwhengagscheduledgpre-registeredgpatientgarrivesgforgservice?g-
ganswer>>.Registeringgthegpatientgandgdirectinggthegpatientgtogthegservicegarea
Ingadditiongtogbeinggsupportedgbyginformationgfoundgingthegpatient'sgchart,gagCMSg1500gclaimgm
ustgbegcodedgusinggwhat?g-ganswer>>.HCPCSg(HealthcaregCommongProceduregCodinggsystem)
Whatgresultsgfromgagdeniedgclaim?g-ganswer>>.Thegprovidergincursgreworkgandgappealgcosts
Whygdoesgthegfinancialgcounselorgneedgpricinggforgservices?g-
ganswer>>.Togcalculategthegpatient'sgfinancialgresponsibility
Whatgtypegofgprovidergbillsgthird-partygpayersgusinggCMSg1500gformg-ganswer>>.Hospital-
basedgmammographygcenters
Howgaregdisputesgwithgnongovernmentalgpayersgresolved?g-
ganswer>>.Appealgconditionsgspecifiedgingthegindividualgpayer'sgcontract
ThegimportantgmessagegfromgMedicaregprovidesgbeneficiariesgwithginformationgconcerninggwhat
?g-ganswer>>.Rightgtogappealgagdischargegdecisiongifgthegpatientgdisagreesgwithgthegservices
Whygdogmanagedgcaregplansghavegagreementsgwithghospitals,gphysicians,gandgotherghealthcaregp
rovidersgtogoffergagrangegofgservicesgtogplangmembers?g-
ganswer>>.Togimprovegaccessgtogqualityghealthcare
, IfgagpatientgremainsganginpatientgofgangSNFg(skilledgnursinggfacilitygforgmoregthang30gdays,gwhatgisgt
hegSNFgpermittedgtogdo?g-ganswer>>.SubmitginterimgbillsgtogthegMedicaregprogram.
90.gMSPg(MedicaregSecondarygPayer)grulesgallowgprovidersgtogbillgMedicaregforgliabilitygclaimsg
aftergwhatghappens?g-
ganswer>>.120gdaysgpasses,gbutgthegclaimgthengbegwithdrawngfromgthegliabilitygcarrier
WhatgdatagaregrequiredgtogestablishgagnewgMPIgentry?g-
ganswer>>.Thegpatient'sgfullglegalgname,gdategofgbirth,gandgsex
Whatgshouldgthegprovidergdogifgbothgofgthegpatient'sginsurancegplansgpaygasgprimary?g-
ganswer>>.Determinegthegcorrectgpayergandgnotifygthegincorrectgpayergofgthegprocessinggerror
WhatgdogEMTALAgregulationsgrequiregon-callgphysiciansgtogdo?g-
ganswer>>.Personallygappeargingthegemergencygdepartmentgandgattendgtogthegpatientgwithingagr
easonablegtime
Atgthegendgofgeachgshift,gwhatgmustghappengtogcash,gchecks,gandgcreditgcardgtransactiongdocume
nts?g-ganswer>>.Theygmustgbegbalanced
WhatgwillgcausegagCMSg1500gclaimgtogbegrejected?g-
ganswer>>.Thegprovidergisgbillinggwithgagfuturegdategofgservice
UndergMedicaregregulations,gwhichgofgthegfollowinggisgnotgincludedgongagvalidgphysician'sgordergf
orgservices?g-ganswer>>.Thegcostgofgthegtest
howgaregHCPCSgcodesgandgthegappropriategmodifiersgused?g-
ganswer>>.Togreportgtheglevelg1,g2,gorg3gcodegthatgcorrectlygdescribesgthegservicegprovided
