Duke Followup

1.

1 point

There is new column added to your Wqs – Account Type. This will indicate if the guarantor account is Personal/Family, BH or WC?

True

False

2.

1 point

Medicare Part C processed claim and paid / patient responsibility. When Medicaid denied the claim with MA04 along with 01704 or 01703 (RECIPIENT ELIGIBILITY INDICATES MEDICARE PART C / NO PART C PRESENT). What action will you take?

We need to call Medicaid and verify what coverage / Plan they have We need to call Medicaid and verify what coverage / Plan they have on file for part C

Do not touch those invoice

Transfer to Reg WQ

Defer for 30 days

3.

1 point

When claim filed to Senior Community Care – Hospice claims, what action will you take?

Update spreadsheet and escalate to supervisor.

Transfer to WQ 1874 for review.

Call payor and check claim status.

None.

4.

1 point

Dos 07/25/16 and claim submitted to insurance on 07/27/2016 still the claim is not yet generated and shows as pending status, What action will you take?

Resubmit claim again to insurance.

Defer for 3 days to allow claim to adjudicate in system.

Defer as per deferral sheet.

None.

5.

1 point

For a W/C (workers comp) claim if the DOS is 06/01/2016 of which the billed amount is $155.00 the claim was submitted on 06/02/2016, What is the deferral guidelines time to allow for insurance to response.

45 Days

75 Days

30 days

60 Days

6.

1 point

If invoice denied for past timely manner and we submitted claim after the timely filing limit of which the billed amount of the claim is $999.99 how is the adjustment taken?

Through maestro care.

Escalate to supervisor.

Through Hyland adjustment form.

None of the above.

7.

1 point

Medicaid denials for immunization admin codes, if we see Medicaid denials and the CPT is 90460 with an office visit. What action will you take?

Escalate to supervisor

Transfer to Coding WQ

Defer for 30 days

None of the above

8.

1 point

When claim submitted as dummy claim with PRV modifier what action will you take?

Adjustment

Defer for 30 days

Resubmit

Transfer to coding

9.

1 point

The Medicaid Pregnant Women plan. Any service prior to 03/01/2016 must be billed under the Medicaid plan and not the Medicaid Pregnant Women plan?

True

False

10.

1 point

Medicare ophthalmology invoice with 52 Modifier. What action will you take?

Defer for 60 days

Defer for 45 days

Transfer to Coding WQ

Defer for 30 days

Duke Followup_July-16