Radiology Billing - Synergy

Question 1

FIU

Facility

Insurance

Undecided

Answer 1

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)

Question 2

When calling Payer/ Health Plan for subscriber information I will need?

Answer 2

Our
*NPI
*PTAN
*Sub info

Info we need
Health Plan?
(address, phone)
Is it active?
Effective Date?

Question 3

PPO

HMO

Answer 3

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.

Question 4

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.

Answer 4

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)

Question 5

When you open MediMatrix and the Insurance indicates the following;

Answer 5

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)

Question 6

Keyboard Controls:
Control C

Answer 6

Copy

Question 7

Control V

Answer 7

Paste

Question 8

Control X

Answer 8

Cut

Question 9

Humana

These claims start with “H”

Answer 9

When we’re doing the Eligibility we need to find out who is the Health Plan HMO/IPA etc.

Question 10

Medi-Cal patients…
(Only if Medi-Cal is primary we search eligibility. Don’t worry about eligibility if it’s secondary)

Answer 10

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”

Question 11

Monarch Ins.

Answer 11

The Payer eligibility info found in SCAN.

Question 12

Kaiser

Answer 12

Add 4 zeros in front of the subscriber number.

Question 13

Yo puedo! Yo puedo!

Answer 13

Dentro de mi existe la misma Inteligencia Q hace girar los planetas en el inmenso espacio.

Question 14

Modifier GW

Answer 14

Is for Hospice
and it’s added in MediMatrix on the Claim with the pencil, and you go to the section CPT (not ICD).

Question 15

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.

Answer 15

Find out in the Noridian portal when the Hospice started and if it ended then we don’t bill Hospice.

Question 16

Keep in mind:

Answer 16

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.

Question 17

MA75 Denial

Answer 17

No SOF

Signature On File

Question 18

Skilled is…

Custodial is…

Answer 18

Part A

Part B

Question 19

X-ray Modifier

*There are several components to Radiology Billing (Technical, Professional and Body Part and Transportation)

Answer 19

TC - 26

TC - is the Technical Component

26 - Professional Component

Question 20

Monarch

Subscribers starts with 310

Answer 20

Search under SCAN

If subscriber starts with 310

Question 21

HMO

Answer 21

will most likely have an IPA

We bill the IPA

(Kaiser is an exception)

Question 22

Front Runner

Answer 22

Is a data base platform where one can search insurance, beneficiary information.

Question 23

MBI

Answer 23

In Noridian to search subscriber by SS, Name, DOB.

Question 24

On Primary Insurance

Answer 24

*We need effective date

*If we have ending also include that

*Not needed on Secondary.

Question 25

Is Subscriber number starts with
100-310

Answer 25

Search in SCAN.

Question 26

In the “Comments” box where you indicate all searches for Eligibility it’s important to?

Answer 26

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.

Question 27

IEHP
Is a Health Plan NOT an HMO.

Answer 27

*Is usually secondary insurance.

*Copy the Medicare number and search Noridian.

Question 28

(Desert Oasis HC) Policy starts with
311
400

Answer 28

Search SCAN for eligibility

Question 29

Policy ends with
01

Answer 29

It will most likely be

*United
*Brand New
*Universal

and it might have HMO to IPA

Question 30

United Web Portal

Answer 30

Reminders’

*Check the Care Provider drop box

*View PCP history to get effective date.

Question 31

Hospice

Answer 31

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.

Question 32

The same is true for United, Scan or any other portal I search for eligibility as with Hospice

Answer 32

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.

Question 33

For any policy subscriber numbers that begin with the letter “H”

Answer 33

it’s Humana.

Humana is found in Availity.

REMINDER:
*Check Payer on top proper insurance co.

Question 34

Humana

Answer 34

PCP: Primary Care Provider is the IPA where we bill it.

Question 35

On the PCC list for each facility

Answer 35

Ctrl F: will take you to a search bar where you can Find by name.

Question 36

Dentro de mi SE’ existe una Inteligencia fotografica a la cual yo estoy conectada en todo momento.

Answer 36

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.

Question 37

United web portal…

Answer 37

Click on the following boxes:

Care Provider

View PCP History

Question 38

Census (some terms)

SNF’s are part of Consolidated Billing (aka Part A)

Answer 38

MCA = MCR A

DOL= ?

LTC= Long Term Care (NOT part A it’s Custodial)

HL= Hospital Leave

Question 39

IEHP

Answer 39

Is a Health Plan (usually secondary, but not always)

Question 40

Molina

Answer 40

Is on Availity

Question 41

When searching patients on PCC for the facility make sure you…

Answer 41

search “All Residents” because that will include discharged residents and based on our DOS we could be looking at a resident who was discharged.

Question 42

When entering Eligibility information on “Comments Box”

Answer 42

Indicate the word “Direct” for Medicare that way we know there’s no IPA associated with the Medicare search.

Question 43

GW Hospice:

Answer 43

For Hospice GW Modifier go to Pencil on Claim Detail Lines (CPT) and enter GW under Modifier(s).

Question 44

TC technical component we bill

Answer 44

26 Professional is the part we write off for Employees CXR

Question 45

Denial
MA75 No SOF

Answer 45

Signature on File

Question 46

R05.9

Answer 46

Cough

Question 47

Scan or any other insurance enter it as 2ndary.

Answer 47

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.

Question 48

Front Runner

Answer 48

Is a Data Base Platform to search patient’s Health Plan.

Question 49

Noridian

Answer 49

MBI is used to search by SS, Name, DOB when you don’t have the Sub#

Question 50

Insurance

Answer 50

*Starting and
*Ending benefits date.
*On 2nd ins doesn’t matter S/E dates.

Question 51

IEHP

Answer 51

It’s usually 2ndary. Copy Medicare Sub# and go to Noridian portal.

Question 52

To write off a Claim

Answer 52

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)

Question 53

IEHP

Answer 53

Reminder:
check Noridian is IEHP has a Mcr number.

Question 54

Yo Soy Una Mujersona..
Triple EEE

Answer 54

Excelente!

Eficiente!

Exitosa!