425 claim denial subdomain iva2 evaluate the revenue

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4.25 Claim denial Subdomain IV.A.2 Evaluate the revenue cycle management processes Subdomain IV.A.2 Take part in selection and development of applications and processes for chargemaster and claims management A patient had a right-posterior subcapsular cataract extraction done with phacoemulsification. An anterior chamber intraocular lens was inserted during the same operative session. The claim is returned with OCE edit 71. Create a line item for the chargemaster that will resolve this issue in the future. Answer Students will need to identify that OCE edit 71 means the claim lacks a device code, and then they should create a chargemaster line as below. Student answers will vary for certain portions of the line created but all the elements of the chargemaster in the top row should be included, and the specifics in red need to be included. (Malmgren and Solberg 2016, 250–252; Casto and Forrestal 2015, 262) References Casto, A. B. and E. Forrestal. 2015. Principles of Healthcare Reimbursement, 5th ed. Chicago: AHIMA. Malmgren, C. and C. J. Solberg. 2016. Revenue Cycle Management. Chapter 8 in Health Information Management: Concepts, Principles, and Practice , 5th ed. Oachs, P. and A. Watters, eds. Chicago: AHIMA. Dept. # Charge # Description Rev. Code HCPCS Code Price Eff. Date Status 101 54321 Ant. Chamber IOL 276 V2630 $2,188.00 12/1/15 Active
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  • Summer '14
  • American Health Information Management Association

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