Answer student responses will vary but should include

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Answer Student responses will vary but should include the following elements: Charge Information Charge status: New, Revision, Deletion Charge Number Charge Description Revenue Code CPT/HCPCS Code Cost Requestor Name and contact information Routing sign off (depends on internal policy but may include at a minimum) HIM—CPT code, revenue code Accounting—cost Administration—final approval (AHIMA 2010; Malmgren and Solberg 2016, 251–252; Richey 2001, 51–55) References American Health Information Management Association. 2010. Care and maintenance of chargemasters (updated). bok1_047258.hcsp?dDocName=bok1_047258 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. Richey, J. 2001. A new approach to chargemaster management. Journal of AHIMA 72(1): 51–55.
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Copyright ©2017 by the American Health Information Management Association. All rights reserved. 209 4.19 Remittance advice Subdomain IV.A.2 Evaluate the revenue cycle management processes Subdomain IV.A.1 Manage the use of clinical data required by various payment and reimbursement systems The claim for S. Smith, a 10-year-old that had a tonsillectomy on 5/8/15, was billed with the following information on May 12, 2015. S. Smith 123 New Road Bridgeville, OH 44556 DOB 6/12/1950 CPT code 42825 Claim adjustment reason code (CARC) 6 returned on the remittance advice to indicate the procedure was not paid. Determine the issue that the CARC identifies and what steps must be taken to correct it. Answer CARC 6 indicates the procedure is inconsistent with the patient’s age. The CPT code is for a tonsillectomy for someone younger than 12 years of age. The patient’s DOB submitted on the bill makes them 65 instead of 10. The patient’s DOB needs corrected in the system and the bill resubmitted. (Casto and Forrestal 2015, 255–256; WPC 2015) References Casto, A. B. and E. Forrestal. 2015. Principles of Healthcare Reimbursement, 5th ed. Chicago: AHIMA. Washington Publishing Company. 2015. Claim Adjustment Reason Codes. reference/codelists/healthcare/claim-adjustment-reason-codes/
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210 Copyright ©2017 by the American Health Information Management Association. All rights reserved. 4.20 Claim reconciliation Subdomain IV.A.2 Evaluate the revenue cycle management processes Subdomain IV.A.1 Manage the use of clinical data required by various payment and reimbursement systems Mrs. Jones had an arthroscopic shoulder procedure on 7/8/15. Her physician performed a subacromial decompression. The coder assigned CPT 29826 to the encounter. The bill dropped on 7/12/15. On 7/22/15, the patient accounting department was processing the latest remittance advice and remark code N122 was attributed to the CPT code for this claim.
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