Identifying Claim Adjustment Reason Codes: Matching Situations |

School: Rasmussen College, Saint Cloud - Course: MEDICAL CODING 2 M131/HIM11 - Subject: Accounting

Ch. 13 Worksheet Identifying Claim Adjustment Reason Codes and Remark Codes In the first part of this assignment you will be matching adjustment reason codes with the following situations.See pages 413-415 in your book for Claim Adjustment Reason Codes 1. $25 deductible: 1 2. Billed a colonoscopy and biopsy without the 59 modifier (failed to follow CCI edits): 4 3. You found out after billing the patient for 6 months that they had BCBS insurance.BCBS only allows 4 months to submit claims.: 29 4. Patient's insurance ended 3/31 and we billed $600 for services 4/2: 27 5. A physician interpreted an EKG at 12:02AM 4/30.Patient died at 11:59 PM 4/29: 13 6. Billed Medica $100.Patient has met their deductible and has an 80/20 plan.How would they deny the $20: 37 7. Keyed a diagnosis of abnormal menstruation on a male physical in error: 7 8. Coordination of benefits issue: 22 9. We obtained a prior authorization for surgery but didn't include it on the claim: 15 10. BCBS denied indicating auto should be paying the claim: 62 Using the same link as above, indicate what should be done for each of the following situations: appeal the claim, write it off, bill the patient, or resubmit the claim.Remember that when a claim is rejected, the provider may correct and resubmit the claim, but it cannot be appealed.When a claim is denied, the provider cannot resubmit the claim but can appeal the decision. 1. A claim paid zero dollars by the insurance company.Reason code is PR-01.What should be done? Bill patient 2. A claim was rejected.Reason code is CO-04.What should be done? Fix the claim and resubmit after correcting modifier issue. 3. A claim was denied.Reason code is CO-29.What should be done? Appeal because the filing time was expired

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