Medicare/Medicare HMO Quiz

Claim denied for Medical Necessity (OP) What activity code will you use in EPIC?

• 94401

• 555

• 518

• 118

Smart Text Letter can be sent using Epic Account Activity 298?

• True

• False

When the expected balance is not meet (Expected Amount is not equal to payer allowed amount) what is correct follow up?

• Will take account activity 1278 to enter the general notes

• Update the Billing Indicator to "3M - Re-evaluation needed (685)

• Will route to Log Variance [93133] by Select Bucket Activity

Claim denied for Medical Records, what action will be taken in EPIC?

• Account activity 382

• Account activity 518

• Bucket activity 9368

What is the follow up on DRG Downgrade claim (Where Correspondence or Rational letter is Available in Epic)

• Will route to denial DRG Audit [1096] by taking account activity and Follow Up Activity-Update Denial/Remark [94401] and update the status 133 DRG Audit Pending Review

• Will take Follow Up Activity-Update and update the status 133 DRG Audit Pending Review

• Will call the payer and ask he reason for recoupment on DRG Downgrade and take Follow Up Activity-Update and update the status 133 DRG Audit Pending Review

How to Transfer the balance to Next Responsible Party?

• By taking account activity 9329

• By taking bucket activity 9329

• By taking account activity 1278

• None of them