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On-Line Library Maintain and Organize Favorites
John Behn, MPA Laurie Daigle, CPC
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Retain most current policies and procedures
Payor Policy Library On-line Libraries Retain most current policies and procedures Easily organized by payor and product Accessibility improves billing and follow-up speed and accuracy Instant and current pre-authorization and drug approval information 2
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Must Have Links for Medicare
Payor Policy Library Must Have Links for Medicare Transmittals Manuals NCDs and LCDs CCI edits Addendum B Physician Fee Schedule Database Clinical Lab Fee Schedule 3
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All transmittals organized by Year Ability to sort by:
Payor Policy Library Transmittals All transmittals organized by Year Ability to sort by: CR# (Change Request Number) Date Transmittal Number Searchable by date or word search Example: New Patient Discharge 4
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Organized by publication number and description
Payor Policy Library Internet Manuals Organized by publication number and description Detailed information on all Medicare changes and requirements Observation 5
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Medicare Coverage Database
Payor Policy Library Medicare Coverage Database Search: allows users to search NCDs and LCDs by keyword, topic date Index: list of national and local coverage determinations Reports: current reports of national and local coverage Download: complete set of LCDs and articles, and NCDs 6
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NCCI MUEs P to P edits (NCCI) Add-on code edits
x.html
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Medicare Fee Schedules
Hospital for-Service-Payment/Hospitaloutpatientpps/Downloads/2017-January- Addendum-B.zip Physician Payment/PhysicianFeeSched/index.html Lab Payment/ClinicalLabFeeSched/index.html Proposed and Final Rules Payment/HospitalOutpatientPPS/Hospital-Outpatient-Regulations-and- Notices.html
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Medicaid West Virginia
Provider Manual Unicare Provider Manual edical/notertiary/pw_a pdf
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Provider Resource Center https://prc.highmark.com/rscprc/hwvbcbs/pub
Payor Policy Library Blue Cross Home Page fm-home-page.html&docId=509&CSRFTOKEN= Provider Resource Center E subscribe Radiology Prior Authorization mgmt-prior- authorization.html&docId=1420&CSRFTOKEN= 10
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United Healthcare PreLoginMain&forwardToken=PreLoginMain Prior Authorizations nelId=12f8c7958f5fa010VgnVCM100000c520720a____ Manuals and Policies nelId=ca174ccb4726b010VgnVCM100000c520720a____
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Aetna http://www.aetna.com/healthcare-professionals/index.html
Clinical Policy Bulletins Searchable, Alpha or numeric bulletins.html Newsletter news/provider-newsletters.html Manuals education-manuals/provider-manuals.html
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Cigna Nav%3Bhealth-care-professionals Policies care-professionals/clinical-payment-and-reimbursement- policies/?WT.z_nav=healthcare- professionals%3BIWantTo%3BView%20Policies
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Coding Resources Modifier fact sheets
resources/modifiers/ NDC to HCPCS Crosswalk CPT Errata corrections
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Billing ANSI Codes http://www.wpc-edi.com/reference/ UB Fields
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http://www.fda.gov/Drugs/InformationOnDrugs/ucm142438. htm
Payor Policy Library Help Tools Unit Conversion Drug help tools htm 16
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Cook - http://www.cookmedical.com/ccodes.do?sbu=esc
Payor Policy Library Supply HCPCS Cook - American Medical Systems &baseTile=corpweb&searchType=corpweb_all¤tPage=1&q= AMPLATZ m professionals/reimbursement.html St Jude m-ep- 2016/15468sjmcrm reimbursementguidesheetr4fnlldrg b.pdf Choose Cook The GPN G05183 to see if device dependant 17
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Patient Assistance - Drugs
assistance/patient-assistance-foundation-enrollment support.html
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http://www.fda.gov/Drugs/InformationOnDrugs/ucm142438. htm
Payor Policy Library Additional Links Unit Conversion Drug help tools htm Quest Diagnostics e.action ACR Appropriateness Criteria 19
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Choose “New Folder” option and name by payor or tool grouping
Payor Policy Library Organize Favorites From website, click “Favorites” in toolbar and choose “Add to Favorites” Choose “New Folder” option and name by payor or tool grouping Name of link can be changed to any name easily recognized 20
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Choose “New Folder” option and name by payor or tool grouping
Payor Policy Library Organize Favorites Blue Cross Coding Commercial Help Tools Medicare From website, click “Favorites” in toolbar and choose “Add to Favorites” Choose “New Folder” option and name by payor or tool grouping Name of link can be changed to any name easily recognized 21
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Maintain folder organization and naming conventions
Payor Policy Library Maintain Library Maintain folder organization and naming conventions Remember to rename links using a consistent process that makes sense, so the link can be easily retrieved If it takes more than a minute to find a link in your favorites, consider moving and renaming Ask yourself where you looked, what name you searched and transfer or rename Each time you perform an internet search, ask yourself if you will need the reference again and save only what you will need in the future 22
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Thank You Stroudwater Revenue Cycle Solutions was established to help our clients navigate through uncertain times and financial stress. Increased denials, expanding regulatory guidelines and billing complexities have combined to challenge the financial footing of all providers. Our goal is to provide resources, advice and solutions that make sense and allow you to take action. We focus on foundational aspects which contribute to consistent gross revenue, facilitate representative net reimbursement and mitigate compliance concerns. Stroudwater Revenue Cycle Solutions helps our clients to build processes which ensure ownership and accountability within your revenue cycle while exceeding customer demands. Contact us to see how we can help. Laurie Daigle, CPC John Behn, MPA
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