lisanewton1
im taking an insurance billing class with a case study of patient…
im taking an insurance billing class with a case study of patient information. Numbers 1 and 2 on the step-by-step completion of instruction states, Note: Form locator (FL) descriptions indicate whether data entry for Medicare claims is required (mandatory), not required (optional), not used (leave FL blank), or situational (dependent on circumstances clarified in the FL instructions). Payer-specific instructions can be located by conducting Internet searches. 1 Billing provider name, address, and telephone number (REQUIRED) ? Enter the provider name, city, state, zip code, telephone number, fax number, and country code. ? Either the provider’s post office box number or street name and number may be included. The state can be abbreviated using standard post office abbreviations, and five- or nine-digit zip codes are acceptable. 2 Billing provider’s pay-to address (SITUATIONAL) Enter provider name, address, city, state, zip code, and identification number if the pay-to name and address information is different from the billing provider information in FL1. Other wise leave it blank. On the case study, all it gives was Alfred Medical Center, 548 N Main St, Alfred NY 14802. It does not give no other information on the form. My question is, shall I enter Alfred Medical Center, 548 N Main ST, Alfred NY 14802 on line 1 and 2.
Line 5,6,. On the step by step completion of instruction, it states, Federal tax number (REQUIRED) Enter the facility’s federal tax identification number in 00-0000000 format. 6 Statement covers period (from-through) (REQUIRED) Enter beginning and ending dates of the period included on this bill as MMDDYY. But on the Case STudy, It does not show federal tax but it does shows EIN number. My question is, shall I type in the EIN number or leave it blank? Number 6, Im not fully understanding statement covers period. Case study, the dates that was given is date/time of outpatient visit.
Number 36, on the step by step instruction, it states, Occurrence span code and dates (SITUATIONAL FOR INPATIENT CLAIMS) Enter occurrence span code(s) and beginning/ending dates defining a specific event relating to this billing period as MMDDYY for inpatient claims. (Sample of occurrence span codes listed below.) 70 Qualifying stay dates (Medicare Part A SNF level of care only) or non-utilization dates (for payer use on hospital bills only) 71 Hospital prior stay dates 72 First/last visit (occurring in this billing period where these dates are different from those in FL6) 74 Noncovered level of care 75 SNF level of care. Note: For a comprehensive list of occurrence span codes, refer to Chapter 25 of the medicare claim. But there is no chapter 25 in this book. On the case study, all it showsoutpatient visit dates. Can you please specify that for me because I do not see it on the case study?
Number 39. on the step by step instruction, it states, Value codes and amounts (REQUIRED) ? Enter two-character value code(s) and dollar/unit amount(s). ? Codes and related dollar or unit amounts identify data of a monetary nature necessary for processing the claim. Negative amounts are not allowed, except in FL41. If more than one value code is entered for the same billing period, enter in ascending numeric sequence. Lines “a” through “d” allow for entry of up to four lines of data. Enter data in FL39a through 41a before FL39b through 41b, and so on. Codes used for Medicare claims are available from Medicare contractors. (Sample of value codes listed below)01 = Most Common Semi-Private Rooms 02 = Provider Has No Semi-Private Rooms 08 = Lifetime Reserve Amount in the First Calendar Year 45 = Accident Hour 50 = Physical Therapy Visit A1 = Inpatient Deductible Part A A2 = Inpatient Coinsurance Part A A3 = Estimated Responsibility Part A B1 = Outpatient Deductible B2 = Outpatient Coinsurance . This patient is a outpation, and the only dollar amount is 950.00. There is no other dollars amount.
Number 39-42. the step by step states, Value codes and amounts (REQUIRED) (cont’d ) Note: When submitting claims for denied charges and days, enter value code 80 (number of days covered by primary payer as qualified by payer), the number of covered days in the amount field for form locators 39, 40, and 41 (e.g., entry 80 12.00 indicates that the amount of 12 days were covered). Then, enter value code 81 (days of care not covered by primary payer) and the number of days that were not covered (e.g., entry 81 1.00 indicates that the amount of one days was not covered). Do not count the day of discharge for covered days. (An inpatient length of stay counts the day of admission, but not the day of discharge.) The sum of covered days and noncovered days must equal the number of days in “From-Through” of Form Locator 6. 42 Revenue code(s) (REQUIRED) Enter four-character revenue code(s) to identify accommodation and/or ancillary charges. Note: When completing UB-04 claims in this chapter, revenue codes are provided in case studies. Revenue codes entered in FL42 explain charges entered in FL47. They are entered in ascending numeric sequence, and do not repeat on the same bill. (Sample revenue codes listed below.) 010X All-inclusive rate (e.g., 0100, 0101) 0 All-inclusive room and board plus ancillary 1 All-inclusive room and board Note: For a comprehensive list of revenue codes, refer to Chapter 25 of the Medicare Claims Processing Manual (www.cms.gov). 43 Revenue description (NOT REQUIRED) Enter the narrative description (or standard abbreviation) for each revenue code, report ted in FL42, on the adjacent line in FL43. (This information assists clerical bill review by the facility/provider and payer. But on the case study, she was there for only 1 day. Her insurance is Medicare. Her RVU is 1.05. Her case study does not shows value codes. The only it shows is the ICD code D24.1 and Revenue code is 0314. How to solve that?
Number 43. it states Revenue description (NOT REQUIRED). Enter the narrative description (or standard abbreviation) for each revenue code, reported in FL42, on the adjacent line in FL43. (This information assists clerical bill review by the facility/provider and payer. The case study shows service description, Excision of mass, right breast. Revenue code is 0314. My question is, is service description is revenue description? Shall I put service description on Block 43 or leave it blank?
Block 52, step by step instruction form, it states, Release of information certification indicator (REQUIRED) Enter the appropriate identifier for release of information certification for each payer, which is needed to permit the release of data to other organizations to adjudicate (process) the claim. I Informed consent to release medical information for conditions or diagnoses regulated by federal statutes Y Provider has on file a signed statement permitting the release of medical/billing date related to a claim. Case study, all it gives is the primary payer mailing address, responsible physician NPI. It doesn’t give release of information on the case study. My question is , leave it blank?
Block 57, step by step instruction form, 57A-C Other provider ID (SITUATIONAL) Enter other billing provider identification number(s), if required by the payer. On the case study, it states source of admission, physician referral with no NPI number , but there is no name given other than responsible physician which is Bill waters, MD. My question is, since they didn’t give a physician referral name, shall I leave that block blank? Bill Water, MD is the only name mention on the case study.
Block 66, on the step by step instruction, it states, ICD revision indicator (REQUIRED) Enter the indicator to designate which version of ICD was used to report diagnosis codes. 0 Tenth revision (ICD-10-CM). My question is, are they asking for the ICD code which is D24.1? That is the only ICD code there is on the case study. Here is the another instruction that is part of 66. Other diagnosis code(s) and present on admission (POA) indicator(s) (SITUATIONAL) Enter ICD-10-CM codes for up to eight additional diagnoses if they coexisted (in addition to the principal diagnosis) at the time of admission or developed subsequently, and which had an effect upon the treatment or the length of stay (hospital inpatient) or if they coexisted in addition to the first-listed diagnosis (hospital outpatient). Note: ? Do not enter the decimal in the reported ICD-10-CM code because it is implied (e.g., E119 instead of E11.9). ? Do not report ICD-10-CM diagnosis codes on nonpatient claims for laboratory services when the hospital functions as an independent laboratory. ? Effective January 1, 2011, CMS expanded the number of other (secondary) significant diagnosis codes reported from 8 to 24. CMS is conducting an analysis of the entire claims processing system to determine the changes needed to process the additional ICD codes (e.g., increasing the number of procedure code fields required for electronic submission of UB-04 data). It is unknown whether the UB-04 claim will be similarly revised to expand the number of procedure code (and date) field.
Block 78 and 79. it states, Other provider name and identifiers (SITUATIONAL) Enter the name and NPI number of the provider that corresponds to the following qualifier codes: DN Referring Provider (The provider who sends the patient to another provider for services. Required on outpatient claims when the referring provider is different from the attending provider.) ZZ Other Operating Physician (The individual who performs a secondary surgical procedure or assists the operating physician. Required when another operating physician is involved.) 82 Rendering Provider (The health care professional who delivers or completes a particular medical service or nonsurgical procedure. Required when state or federal regulations call for a combined claim, such as a claim that includes both facility and professional fee components.) My question is, would that be DN. This patient did had a physician referral but no name connect this this physician referral.
