I. FUNDAMENTALS IN BILLING

  • A. Insurance Revenue Cycle (How MSI Gets Paid)
  • B. State Limits And Waivers Items
  • C. MSI Systems and Applications
    • C.1. Billing Workstation
    • C.2. Csr Workstation
    • C.3. Web Portals
      • C.3.1. PA/MA
      • C.3.2. DEMAP
      • C.3.3 Other State Portals
    • C.4. Other MSI Applications
      • C.4.1. Spark
      • C.4.2. 3cx
      • C.4.3. MSITime

II. INSURANCES

  • A. Non Payers
    • A.1. Medicare
    • A.2. Medicare Advantage Plans
    • A.3. Commercial Plans
    • A.4. Medigaps And Supplemental Plans
    • A.5. Life Insurance, Dental And Pdp Plans
  • B. Payers
    • B.1. Medicare
    • B.2. State Medicaid
    • B.3. Mcos
    • B.4. Chcs
  • C. Par And Non Par Insurances
  • D. Insurance Set Up
    • D.1. Ins Plan Name
    • D.2. Address/ Payer Id
    • D.3. Claim Submission/ Remittance Advice
      • D.3.1. 837 Vs Print
      • D.3.2. 835 Vs Print

III. ELIGIBILITY

  • A. Portals To Check On For Eligibility
    • A.1. PA/MA
    • A.2. DEMAP
    • A.3. Other State Portals
    • A.4. CHC Portals
    • A.5. Emdeon
    • A.6. Office Ally
    • A.7. Navinet
    • A.8. Optum
    • A.9. Availity
  • B. Updating Insurance Plans For A Cons In The Sytem
  • C. Updating Billing Path
    • C.1. Marking Orders As ‘DELIVERED’

IV. BILLING

  • A. Billing Status
  • B. HCPCS
  • C. Sale Price
  • D. Notes/Documentation
  • E. EDI
    • E.1. Understanding Denials
      • E.1.1. Denial – Adjustment Reason Codes
      • E.1.2. Types of Denials
        • E.1.2.1. Good Vs Bad Denials
    • E.2. Understanding Payments
      • E.2.1. Units And Fee Schedule
      • E.2.2. Payment/ Check Information
      • E.2.3. Payment – Adjustment Reason Codes

V. DENIAL MANAGEMENT

  • A. Understanding Denial Codes
  • B. Rebilling Claims
    • B.1. Filing Deadline
    • B.2. Identifying Billing Problems And Solutions
    • B.3. Corrected Claims
      • B.3.1. Resubmission Codes
      • B.3.2. Reference Numbers
      • B.3.3. Sending as RB-Nw
      • B.3.4. Sending as RB-Go

VI. APPEALS AND WRITEOFF

  • A. Timely Filing For Appeals
  • B. Suggesting Writeoff