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CH 8, 9, & 10 Other

Code Sets, Medicare Claim Levels, & Credit and Collection Term

The level for a Hearing Officer(reconsideration) Level 2
The level for a Redetermination (Telephone, letter, or form) Level 1
The level of the Departmental Appeal Board Review Level 4
The level for the Judicial Review in the US District Court Level 5
The Level for the Administrative Law Judge (ALJ) Hearing Level 3
Standard Code Sets for Diseases and Injuries ICD-9 Codes
Standard Code Sets for Physician Services CPT Codes
Standard Code Sets for Pharmaceuticals and Biologics Nation Drug Codes for Retail Pharmacy
Debtor An individual owing money
Discounts Reductions of the normal fee based on a specific amount of money or percentage of the charge
Dun Message A phrase to remind a patient about a delinquent account
Itemized Statement Detailed summary of all transactions of a creditors' account
Financial Account Record (Ledger) An Individual record indicating charges, payments, adjustments, balances owed for the service rendered
Debit Card An item that permits bank customers to withdraw cash at any hour from an ATM
Fee Schedule Listing of accepted charges or established allowances for specific medical procedures
Creditor A person to whom money is owed
Lien A claim on the property of another as a security for a debt
Benefits of using HIPAA standard transactions and code sets on the 837P: Improves accuracy, More efficient/Timely, Faster reinbursement back, Easy to use Reliable Tracks forms, Saves money
Data Required Refers to the data element that must be used to be in compliance with HIPAA
Data Situational Means that the item depends on the data content or context
A procedural Code (R or S) Required
Procedural code Modifier (R or S) Situational
Work Return Date (R or S) Situational
Provider's Signature (R or S) Required
Patient's Last Menstrual Period (R or S) Situational
Dates of Service (R or S) Required
EOB STEPS (ESSAY-PART 1) 1. You read it and pull the claims. 2.You make sure that it is accounted for. 3.You then check to see if it is paid or not. If it is paid, it can be closed and filed. The check/voucher should be deposited
EOB STEPS (ESSAY-PART 2) 3.If it is not paid, you have to tell the patient and start a claim proccess. If it has been rejected/pending, you have to correct and resubmitt. 4.Have a tickler file for any info that is not on the EOB (Lost/Never Received)
Collecting Money/Administration Part (All part of a Tickler) 1.Education for the pt and payment policy2.Bill Form/Encounter Form (collect copay & veryify info)3.1st bill owed4.Wait 30 days for 2nd bill-past due & Dun Message5.Telephone follow up6.Collection Agency/Legal Action
Created by: lorireid1980