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Interview Prep (1) - Converted-Converted-Compressed

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56 views5 pages

Interview Prep (1) - Converted-Converted-Compressed

Uploaded by

abdul.191350
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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RCM Cycle

Appointment Scheduling

Eligibility and Benefits Verification

Registration

Encounter

Medical transcription

Medical Coding

Demo Entry & Charge Capture

Claims Generation and Submission

Clearing House

Insurance Office

Payment Posting

Accounts Receivables

Denial Management

Collections

Modifiers

MOD 21-Prolonged E&M service


MOD 22-Unusual Procedural Service
MOD 23-Unusual Anesthesia
MOD 24-Unrelated E&M service
MOD 25- separately identifiable E&M service by the same physician on the same day of
a procedure
Mod 47-Anesthesia by surgeon
MOD 26 - PROF COMP
MOD 50 - BILATERAL PROC
MOD 51 MULITPLE PROC
MOD 54 Surgical care only
MOD 57 Decision for surgery
MOD 59 Distinct Procedural Service
MOD 62 TWO SURGEONS
MOD 66 SURGICAL TEAM
MOD 76 - REPEAT BY SAME Phy
MOD 77 - REPEAT BY DIFF Phy
MOD 80- ASSISTANCE SURG
MOD TC - TECH COMP
GA - ABN ON FILE
GZ -ABN NOT ON FILE
GV - Service related to hospice btu phy is not contrated to hospice facility
GW - Service not related to hospice also phy is not contrated to hospice facility
SG - Ambulatory Surgical Center (ASC) facility service
AA - Anesthesia services performed by anesthesiologist

POS
01 pharmacy
02 telehealth
03 School
04 homeless shelter
09 prision
11 OFFICE
12 HOME
13 Assisted Living Facility
for Sr citizen 24/7 assit
14 GROUP HOME
15 MOBILE UNIT
16 TEMP LODGING
17 WALK IN HEALTH CLINIC
18 WORKPLACE
21 INPATIENT
22 OUT PATIENT
23 EM
24 Ambulatory Surgical Center
25 BIRTHING CENTER
26 Military Treatment Facility
31 Skilled Nursing Facility
32 Nursing Facility
34 HOSPICE
Evaluation & Management
The E/M codes is a medical coding process in support of medical billing and represent
services such as office or outpatient services, hospital services, emergency department
services, nursing facility services, rest home services, prolonged services, care
management, preventive medicine, and newborn care.
established by the American Medical Association (AMA).

99201 to 99499
New patient office - 99201-99205
Established patient office - 99211-99215
Emergency department services — CPT codes 99281-99285

Surgery
10040 to 69990

Anesthesiology
00100 to 01999
99100 to 99140

Pathology & Laboratory


80049 to 89399
90281 to 99199

Radiology
70010 to 79999

======================================================
CLAIM FORM

BOX 17/B REFF DOC & NPI


BOX 21 DX CODES
BOX 22 CORRECTED CLM
BOX 23 PRIOR AUTH
BOX 24B POS
BOX 24D CPT/MOD
BOX 24J RENDERRING DOC
BOX 25 TAX ID
BOX 32 SERVICE ADDRESS
BOX 33 BILLING ADDRESS
CHAMPVA The Civilian Health and Medical Program of the Department of Veterans Affairs

CHAMPUS - Civilian Health and Medical Program of the Uniformed Services

COBRA - Consolidated Omnibus Budget Reconciliation Act

DEERS Defense Enrollment Eligibility reporting system

CPT - Current Procedural Terminology

HCPCS - Healthcare Common Procedural Coding System

EDI - Electronic Data Interchange

CMS - Center of Medicaid and Medicare Services

HIPAA - Health Insurance Portability and Accountability Act of 1996

ICD -International Classification of Diseases

PHI – Protected Health Information

HCFA -Health Care Financing Administration

ABN - Advance Beneficiary Notice

DENIALS
CO4 CPT-MOD
CO5 CPT-POS
CO11 DX-CPT
CO15/CO197 NO AUTH
CO16 LACKS INFO
CO18 DUP
CO19 WORK
CO21 NO FUALT
CO22 COB
CO24 CAP
CO27 COVERAGE TERMED
CO29 TFL EXP
CO31 PT NOT IDENTFIED
CO119 MAX BENFIT
CO49 ROUTINE
CO50 MEDICAL NECESITY
CO96 NON COVERED
CO97 INCLUSIVE
CO100 PD TO PT
CO109 ANOTER PAYER
CO252 ATTACHMENT REQ
CO-B15 BUNDLED
M127 MR

MEDICARE DEDUCTIBLE
$198

ESRD - End Stage Renal Disease


PART A - IP, SNF, HOSPICE
PART B - OP, Clinical lab. Services
PART C - MEDICARE ADVANTAGE
PART D - PRESP DRUGS & DME

Clinical Laboratory Improvement Amendments is quality standards for all laboratories testing to ensure
the accuracy, reliability and timeliness of results. Any lab facility performing examinations of human
specimens (e.g., tissue, blood, urine, etc.) for diagnosis, prevention, or treatment purposes. CLIA
Number are used while reimbursement of Lab Charges

National Drug Code, is a unique 10-digit, 3-segment number. It is a universal product code for
human drugs in the United States. The code is present on all non-prescription (OTC) and
prescription medication packages and regulated by FDA.

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