FAQ BILLING QUESTIONS
FAQ BILLING
QUESTIONS
MISSOURI MEDICAID
Incorrect Payment
Hospice Medicaid
Not Approved
2
MISSOURI MEDICAID
3
MEDICARE A
Hospital Stay Issues
Sequential Billing
HMO,MSP & Hospice Overlaps
Missing/Invalid Information
4
MEDICARE A
5
SELF PAY
INVALID CHARGES
MISAPPLIED PYMTS
NOT HAVING A COLLECTIONS POLICY
UN INFORMED RESIDENTS
6
MEDICARE B
Missing/Invalid Modifiers
G Codes
Occurrence Codes
7
MEDICARE B
8
MANAGED CARE
Not Identifying Coverage
Missing Authorization
Level of Care VS.
PPS
HospiceUnbilled
Coinsurance
9
MANAGED CARE
10
COINSURANCE
Dual Eligible
Crossover VS. Non Crossover
Supplemental (Medi-Gap) VS. INSURANCE
11
COINSURANCE
12
COINSURANCE
13
COMMON DDE ERRORS
Verbatim Remarks
Identifying ADR
Status
Adding Modifiers
Rejected Claims
14
COMMON DDE ERRORS
15
COMMON DDE ERRORS
16
COMMON DDE ERRORS
17
COMMON DDE ERRORS
18
COMMON DDE ERRORS
19
COMMON DDE ERRORS
20
COMMON DDE ERRORS
21
COMMON KNOWLEDGE GAPS
Coverage of PPS Assessments
Early-Late-Missed Assessments
Compliance Claims
Leave of Absence
22
FOLLOW UP TIPS
TechnologyDocumenting
Efforts
Consistent Aging
Review
23
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
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