Radiology Billing - Synergy Flashcards
FIU
Facility
Insurance
Undecided
Facility (To Bill Part As)
Insurance (Once we’re ready to bill the insurance the whole list of claims is transferred to this list by clicking the “I” on top)
Undecided (If the claim is missing information, it can be placed back on “U” list and we can look at it later)
When calling Payer/ Health Plan for subscriber information I will need?
Our
*NPI
*PTAN
*Sub info
Info we need
Health Plan?
(address, phone)
Is it active?
Effective Date?
PPO
HMO
Claim goes directly to PPO Payer
If the HMO is Kaiser we bill Kaiser. It it’s a different HMO we need to look for the IPA (NOT Medical Group that’s different) we’re looking for the IPA.
Medicare patients subscribe to HMOs through Medicare Advantage.
(Advantage is different from Humana)
For Eligibility purposes, on the “comments box” I need to indicate all searches…
Start w/ Medicare, followed by the HMO, and thirdly IPA that way for subsequent claims we know what was searched.
When it’s an HMO through Medicare Advantage we need to search the following.
*HMO
*IPA (if patient belongs to IPA this is where we bill)
When you open MediMatrix and the Insurance indicates the following;
Prospect Medical Group or any other Medical Group…. that is NOT the payer.
Medical Groups are NOT payers. HMO usually associated with IPA (except Kaiser)
Keyboard Controls:
Control C
Copy
Control V
Paste
Control X
Cut
Humana
These claims start with “H”
When we’re doing the Eligibility we need to find out who is the Health Plan HMO/IPA etc.
Medi-Cal patients…
(Only if Medi-Cal is primary we search eligibility. Don’t worry about eligibility if it’s secondary)
Sometimes the patient has also signed up for HMO. If Medi-Cal is secondary Medicare will automatically forward to Secondary. Also, on secondary Insurance we don’t need “effective date”
Monarch Ins.
The Payer eligibility info found in SCAN.
Kaiser
Add 4 zeros in front of the subscriber number.
Yo puedo! Yo puedo!
Dentro de mi existe la misma Inteligencia Q hace girar los planetas en el inmenso espacio.
Modifier GW
Is for Hospice
and it’s added in MediMatrix on the Claim with the pencil, and you go to the section CPT (not ICD).
Hospice
Hospice patients we’re still billing Medicare as primary and Hospice information is archived for any future claims.
When you add Hospice to the Insurance we’re Billing “Medicare” and on the next line we input Hospice (this is just for us) then on the S/E dates fill out accordingly.
Find out in the Noridian portal when the Hospice started and if it ended then we don’t bill Hospice.
Keep in mind:
The effective date sometimes is NOT indicated, but if for example you have a patient that was on an HMO or Hospice from this start date to termination date…
Then the next day after termination date becomes effective date on the current insurance policy.
MA75 Denial
No SOF
Signature On File
Skilled is…
Custodial is…
Part A
Part B
X-ray Modifier
*There are several components to Radiology Billing (Technical, Professional and Body Part and Transportation)
TC - 26
TC - is the Technical Component
26 - Professional Component
Monarch
Subscribers starts with 310
Search under SCAN
If subscriber starts with 310
HMO
will most likely have an IPA
We bill the IPA
(Kaiser is an exception)
Front Runner
Is a data base platform where one can search insurance, beneficiary information.
MBI
In Noridian to search subscriber by SS, Name, DOB.
On Primary Insurance
*We need effective date
*If we have ending also include that
*Not needed on Secondary.
Is Subscriber number starts with
100-310
Search in SCAN.
In the “Comments” box where you indicate all searches for Eligibility it’s important to?
Enter every portal we searched.
Example:
Medicare/ Scan/ Hemet IPA etc. etc.
If it’s Medicare Direct, then indicate that.
That way we know already for any subsequent claims what has been searched.
IEHP
Is a Health Plan NOT an HMO.
*Is usually secondary insurance.
*Copy the Medicare number and search Noridian.
(Desert Oasis HC) Policy starts with
311
400
Search SCAN for eligibility
Policy ends with
01
It will most likely be
*United
*Brand New
*Universal
and it might have HMO to IPA
United Web Portal
Reminders’
*Check the Care Provider drop box
*View PCP history to get effective date.
Hospice
Every time we have a MCR subscriber number we search Noridian to see if patient is on Hospice.
We still have to bill Medicare and archive Hospice information and add GW Modifier to the CPT list.
The same is true for United, Scan or any other portal I search for eligibility as with Hospice
If claim is submitted to Hospice, but I searched United then enter United or whatever other insurance the patient has so that we know on any subsequent claims where we obtained the information.
For any policy subscriber numbers that begin with the letter “H”
it’s Humana.
Humana is found in Availity.
REMINDER:
*Check Payer on top proper insurance co.
Humana
PCP: Primary Care Provider is the IPA where we bill it.
On the PCC list for each facility
Ctrl F: will take you to a search bar where you can Find by name.
Dentro de mi SE’ existe una Inteligencia fotografica a la cual yo estoy conectada en todo momento.
Lo unico Q tengo Q hacer para activar en mi vida FyM a la I-DCS Q HGLP EEIE es mantenerme en ACA con mi Vibracion con mi Espiritu.
United web portal…
Click on the following boxes:
Care Provider
View PCP History
Census (some terms)
SNF’s are part of Consolidated Billing (aka Part A)
MCA = MCR A
DOL= ?
LTC= Long Term Care (NOT part A it’s Custodial)
HL= Hospital Leave
IEHP
Is a Health Plan (usually secondary, but not always)
Molina
Is on Availity
When searching patients on PCC for the facility make sure you…
search “All Residents” because that will include discharged residents and based on our DOS we could be looking at a resident who was discharged.
When entering Eligibility information on “Comments Box”
Indicate the word “Direct” for Medicare that way we know there’s no IPA associated with the Medicare search.
GW Hospice:
For Hospice GW Modifier go to Pencil on Claim Detail Lines (CPT) and enter GW under Modifier(s).
TC technical component we bill
26 Professional is the part we write off for Employees CXR
Denial
MA75 No SOF
Signature on File
R05.9
Cough
Scan or any other insurance enter it as 2ndary.
Not just SCAN any other portal you’ve searched and found Beneficiary information so that when you have that patient again you know where you got the info.
Front Runner
Is a Data Base Platform to search patient’s Health Plan.
Noridian
MBI is used to search by SS, Name, DOB when you don’t have the Sub#
Insurance
*Starting and
*Ending benefits date.
*On 2nd ins doesn’t matter S/E dates.
IEHP
It’s usually 2ndary. Copy Medicare Sub# and go to Noridian portal.
To write off a Claim
Select any Insurance on the list (AARP comes up first) choose that one…
For the Subscriber enter: 123 (or any number)
Claim Primary
Click $ (dollar sign)
IEHP
Reminder:
check Noridian is IEHP has a Mcr number.
Yo Soy Una Mujersona..
Triple EEE
Excelente!
Eficiente!
Exitosa!
