Cyrilia, Escalation # 2242 is not a true escalation. You sent to escalation because the service form# SFC20150619018078072 had not been completed. However, after viewing the issue the provider is stated that member has Medicare Part A and doesn’t need to send in the EOB. On the contrary, since the member has primary insurance, the provider would need to send in an EOB with states that primary did not pay anything before this claim can be reprocessed. Please put yourself in Project and call the provider back advising this information. Once this has been done, please let me know and I will adjust your time.
assignment within 48 hours. This includes cancellation due to inclement weather and company or deaf client cancellations.
SC received a telephone call on 10/16/2015 stared 9:34 and end at 9:41 am from Tricia Crooks at Liberty Resources Home Choices (LRHC) Community Outreach and Enrollment Leader. Stating that she spoke Pa and he wants to resume his service order with LRHC for PAS service. SC informed SC that this information will first need to verify with Pa. SC expressed concerns about LRHC being able to fulfill service since they had the case unstaffed for over two weeks (09/25/15-10/15/2015). Tricia apologized on behalf of LRHC, and stated that they have someone assigned and is ready to go all is needed is the resumed service order ASAP. SC again explained to Tricia that Pa has to confirm this besides Pa was very adamant about switching provider because the
Go over checklist with client on Tuesday calls or individual calls with Regionals for property’s in set up. Minol will drive and track.
In your email you mentioned waiting until November to be able to get a Service Extension on our V7R1M0 software. That will probably be a new quote and if it can be for more than one year that would be ideal for us.
The patient is very independent in his home and is able to perform all ADLS within the home without any addtional assistance. MSW asked patient if he was interested in any addtional care giving support in the home, but patient declined addtional support at this time. Patinet stated he gets transportation from his neiabors to the store when needed. MSW offered the patient additional transportation services, but the patient declined needing any addtional transportation services at this time.Patient reported falling back in 2004 off the steps and was air lifted to the hospital. Patient reports having diffculty paying doctors and helicoter bills. Patinet's only income is through SS for $847. Patient reported that was the only time he was fallen in his life. Patinet has only been in the hospital two times during his lifetime. MSW offered life alert services, but the patient was not interested. Patient stated his only concern was being able to afford his doctor and helicotor transportion bills. MSW connected AHCCCS and spoke to represtative regarding getting patient signed up for the medicare savings program. Representative stated the patient has already applied for AHCCCS back in
Most claims today are submitted through an electronic format directly or indirectly through a “clearinghouse” where claims are grouped and sent to the payer. Two primary payment grouping algorithms are DRG’s and APCs, both are used by Medicare for hospital payment and many commercial payers. Providers and payers use claims editing software to detect possible errors in claim submission to assure maximum payment for medical services and to shorten an amount of time from claim submission to payment. CMS has developed the National Correct Coding Initiative (NCCI) to promote national correcting coding methodologies and to control improper coding leading to inappropriate payment (Cleverley 26). CMS also has designated edit checks called the outpatient code edits (OCE). The OCE uses claim-level and line item-level information in the editing process. Each category in the OCE has six dispositions which help to ensure all Fiscal Intermediary/Medicare Administrative Contractor (FI/MACs). The four claim-level is rejection, denial, return to provider, and suspension; and the two-line item-level is rejection and
review the SFL audit report and here is the numbers of patient accounts that we can't bill out to the SFL program b/c the patient don't qualify or never complete the SFL application. Please review my founding and let me know How do you want me handle all this claims. My suggestion is if the patient is active with Title X we can adjusted off under the Title X program and just bill the patient for the Title X copay fee and the lab fee if the patient is scale level is B,C,D,E & F. I will be waiting for the final decision that you and Sara will like to make.
SC received vm from Andy at Marx Medical stated that the Pa’s grab bars was successfully installed but when he attempted to bill for the service he was informed by Promise that the provider code was incorrect. SC reviewed the service order and did not see any problem in the service order so the SC placed a call to the provider and enquired about the billing issue but when the SC called the receptionist stated that Andy was not there yet and when he gets there she will have him call the SC. The SC left contact information and awaits Andy’s call. The SC will f/u with SCS about the about matter. 11:21-11:30
RE: E/M codes 8/5/2015 4:37:46 PM Definitely using the correct E/M code's. Document the code's for reimbursement for medicare, medicaid, or private insurance. Not done correct big lose of money. You make a great point on this one
Customers must use the internet to fill out an online form to address their complaints or service needs. These forms are processed by employees in your department. Currently the turnaround time on any given form is between four to eight hours. This creates a number of other customer complaints. Project Call Center is designed to reduce this turnaround time by 75% by creating and staffing a call center in Tampa. Building acquisition, building renovations, building fit out, IT system upgrades, and hiring and training of staff are estimated to cost $8.5 million dollars. This $8.5 million dollars can be paid evenly in any two quarters in the next year. In addition, seven new employees will need to be hired at $40,000 burdened labor costs per year to staff the call center. Management of this project could easily be done with the current in-house staff. Most of the work of this project would be outsourced and will have minimal impact on day-to-operations.
We receive a payment for Medicare on the new Trizetto account and when I check the EOB the payments are for the 4 first claims submittion that you guys post and send from Cerner .Medicare pay 3 patients only. My question is Do you want me to post the Medicare EOB on Cerner? or Do you want to posted ? I just ask b/c I don't know if you have a different plans on How or Who will be posting the payments on the new system. Please advise.
De-escalation Room:-Used for de-escalation for behavior that could potentially result in injury to self or others. This is not a consequence for behavior
I am going to have to work with our insurance company on this so it is going to be a little delay. I reached out to Matt and left a message.
If they said that they can't send claims,How we can send the claims that we post already on Ezclaim and needs to be corrected if the payer denied the claim? I'm still have a lot of claims that's still pending to paid or rejected by the payers.For example today I have to call Humana and ask for few claims that I have pending for the spreadsheet list that I send to them and they told me that a lot of these claims been paid already on March and they send the payments by check but I never receive the EOB so what I did I went to the website and I upload the EOB so I poosted manually today and on that EOB I receive two denials that I need to rebill back.
In reading the first article Coach Knight: The Will to Win, I found the article found Coach Knight to be very offensive and mean to his players. Coach Knight did not display good leadership skills. According to the article, Coach Knight’s drive and passion for excellence was not always received as well as his record of wins and losses Snook, Per low, Delacey, 2005).