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Transcript

Explorer's Quest

Welcome to Explorer's Quest: Billing Bounty, where the treasures of Claim Basics await your discovery!Your mission will be to follow the treasure map, where X marks the spot, answering questions to uncover treasures.Find all five before sailing home. Are you ready to embark on this journey?

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Explorer's Quest

Patient Data Mismatch

01

02

Billing Bounty: Uncovering the treasures of claim forms!

What digit of the bill type identifies where the services were provided?

digit

2

1

digit

st

3

digit

nd

rd

Answer the question correctly and open the chest.

Explore the coast by clicking on the 'eye-cons' and search for a clue that can help you solve the question.After reviewing the clue, click "Go Back" to answer the question.

Go Back

Incorrect!

Correct!

You found the gold!Click the next X to explore spot 2.

Treatment Codes

02

Explorer's Quest

Billing Bounty: Uncovering the treasures of claim forms!

Treatment Codes

02

An inpatient claim was determined to not meet inpatient criteria after the patient had already been discharged. The provider decided to remove Room and Board charges and bill only Medicare Part B charges.

0

No Authorization

03

04

Correct!

You found the jewels!Click the next X to explore spot 3.

Explorer's Quest

Billing Bounty: Uncovering the treasures of claim forms!

0

No Authorization

03

04

Click the box to reveal the treasure.

Use your mouse to hover over the claim and explore.What field do we enter a resubmission code to indicate a corrected claim?

33

22

11

Charge Lines

Wrong Answer!

33

22

11

Use your mouse to hover over the claim and explore.What field do we enter a resubmission code to indicate a corrected claim?

Charge Lines

This is incorrect! View the claim for the correct field.

This is incorrect! View the claim for the correct field.

Service Codes

04

Correct!

You found a relic!Click the next X to explore spot 4.

Explorer's Quest

Billing Bounty: Uncovering the treasures of claim forms!

Service Codes

04

In a bottle lost at sea, a message hides for you and me.A claim for Telehealth, denied, awaits a seeker's decree.CO-58, Services rendered in an inappropriate place, they say, but where should the claim truly sway? Click on the bottle and view the claim, decide if it should be reviewed or remain the same.Shall we appeal its fate, or to coding it shall go? Solve the riddle, let the claim's story show.

Go Back

Wrong Answer! Take a closer look at how the claim has been billed. Decide its destiny, and let its path be fulfilled.

HINT: Click the remit and hover over the claim form to discover clues.

Hover over the charge lines of the claim and view the POS (Place of Service) code. Does the POS seem to be the appropriate place for a telehealth visit?

Provider Credentialing

05

Correct!

You found ancient armor!Click the next X to explore spot 5.

Explorer's Quest

Billing Bounty: Uncovering the treasures of claim forms!

Provider Credentialing

05

A unique bill for services for specialized end-of-life care.

The first claim of a series of treatment dates.

Services rendered in a Hospital-Based Setting.

The patient has a terminal illness.

Ahoy, seekers! Imagine yourself on a sandy beach, shovel in hand. With each scoop, a clue reveals itself, guiding you closer to the hidden treasure. By combining all 4 clues you will uncover the correct Bill Type.When ready click the starfish and pick the correct Bill Type.

Correct!

You found a huge treasure chest!Click the ship to go home.

Well Done!

You've conquered the Billing Bounty by mastering claim basics and collecting treasures. Please be sure to screenshot this page (or use the Snipping Tool) and submit this image to the facilitator to receive credit.

Explorer's Quest

No Treasure Here.Try Again!

Billing Bounty: Uncovering the treasures of claim forms!

Go Back

Explorer's Quest

No Treasure Here.Try Again!

Go Back

Billing Bounty: Uncovering the treasures of claim forms!

Explorer's Quest

No Treasure Here.Try Again!

Go Back

Billing Bounty: Uncovering the treasures of claim forms!

Explorer's Quest

No Treasure Here.Try Again!

Go Back

Billing Bounty: Uncovering the treasures of claim forms!

Explorer's Quest

No Treasure Here.Try Again!

Go Back

Billing Bounty: Uncovering the treasures of claim forms!

Explorer's Quest

No Treasure Here.Try Again!

Go Back

Billing Bounty: Uncovering the treasures of claim forms!

  • Click the correct area of the claim form to validate the denial and find the treasure!

The claim denied for CO 6, "The procedure code is inconsistent with the patient's age".Where is patient information such as patient's date of birth located on the claim?

CMS - 1500

Pick the correctBill Type.

112

822

821

231

Incorrect! Review the clues and Try Again.

Incorrect! Review the clues and Try Again.

Incorrect! Review the clues and Try Again.

  • Click the correct area of the claim form to validate the denial and find the treasure!

The claim has denied for CO 197, "Precertification/ Authorization absent".Where on the claim can we locate the authorization code?

UB 04

  • Click the correct area of the claim form to validate the denial and find the treasure!

The claim has denied for B 7, "This provider was not certified/eligible to be paid for this procedure/service on this date of service".Where can you locate the Renderring Provider's NPI (National Provider ID)?

CMS 1500

  • Click the correct area of the claim form to validate the denial and find the treasure!

The claim has a CO-199 denial "Revenue Code and Procedure Code do not match".Where can you locate Revenue Codes on the claim?

UB-04

Click the claim image to view the appropriate section of the claim and select the correct resolution below.

Send the Claim to Coding

CO-58 Treatment deemed to have been rendered in an inappropriate or invalid place of service.

Appeal with the Payer

  • Click the correct area of the claim form to validate the denial and find the treasure!

The caim denied for CO 58, "Treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service.Where on the claim can you locate Place of Service?

CMS 1500