Movavi Screen Recorder Studio Movavi Screen Capture Pro Movavi Picverse. Movavi Photo Editor 6. Movavi Photo Manager 2. Movavi Slideshow Maker 8. PDFChef by Movavi Gecata by Movavi 6. Movavi Video Editor 1. Movavi Academic Movavi Video Suite for Mac Movavi Video Editor Plus for Mac Movavi Video Editor for Mac Movavi Video Editor Business for Mac In addition, if the case has been transferred, loaned, retired, or destroyed, data entry is blocked.
If the claimant's name does not agree with the name on the data base, further data entry is blocked. Sometimes first and last names are reversed on a bill. Direct payment is a payment made directly to a provider or other non-claimant.
Payments made to claimants are categorized as reimbursements or non-direct payment. If the bill is for direct payment, key "Y"; if for reimbursement to the claimant, key "N". Most of bills received in the office are for direct payment. However, travel vouchers, pharmacy receipts, and maintenance reimbursements are usually non-direct payments.
The presence of paid receipts or "paid in full" on the bill are also indications of non-direct payment. If the bill is a HCFA, and an "amount paid" is shown in item 29, the bill should be keyed as a non-direct payment. If unable to determine whether the bill is for direct or non-direct payment, key as non-direct, as this will prompt manual review by a bill resolver.
If the bill is for one of these four types of reimbursement, enter "Y". If not, enter "N". Pharmacy reimbursements usually consist of one or more receipts from the pharmacy. Travel reimbursements are usually submitted on form SF Maintenance reimbursements are always on form OWCP Training reimbursements should already be marked up with provider type VR on the bill. If "Y" is entered, the next entry will be provider type. The only provider type codes that should be entered are FR for pharmacy reimbursement, KR for travel reimbursement, QR for maintenance reimbursement, and VR for training reimbursement.
This number is not required for reimbursement of pharmacy, travel, maintenance, or training. If that particular identification number is not on the provider file, an error message will be produced. Double check the number keyed and continue if keyed correctly. This is required only if a tax identification number has been entered. If it matches, respond "Y" to the "Address OK? If it does not match, respond "N" to the "Address OK? Continue until a match is found.
Keying may continue, or offices may choose to pull a bill from the batch at this point and send for security provider file update. If the bill is pulled from the batch because the provider is not on file, an appropriate notation should be made on the CA-D-9 under item 4. This data is used to apply the fee schedule. Usually it will be the same as the provider state and zip. However, this is not always true, so if services were rendered at a location other than the provider address state and zip see item 32 on the HCFA , that information should be entered.
If they match, respond "Y" to the "Address OK? If not, respond "N". For other bills, the provider type is written to the bill record from the provider file record. Most bills are not subject to prompt payment rules. If the bill is not for prompt payment, enter "N". If it is for prompt payment, press "Y" already shows on the screen. Prompt payment bills will have already been screened by someone else in the office, and are usually placed in separate batches from the other bills. The following types of bills are always prompt payment:.
Their services will be coded using a variety of codes starting with the letter N. Entry of a bill number is allowed only if the response to the "prompt payment" question was "Y", or if the payment is for a U. For rehabilitation bills, enter the counselor number. For medical and nurse prompt payment bills, enter the prompt payment number which appears on the bill. If there is no prompt payment number on the bill, make an entry consistent with individual district office policy. The system will accept one to 12 digits.
The system will ask whether an invoice number N or invoice date D will be entered. If the response is "N", then an invoice number consisting of up to eight numeric and alpha characters must be entered. If more than one valid district office date stamp appears on the bill, the oldest date should be used.
A date stamp which has been crossed out and marked as returned is invalid. If there is no date stamp on the bill, look for a notation on the bill as to when it was received in the office, and enter that date.
If there is no indication on the bill as to date of receipt, enter today's date. Note: if there is more than a very occasional bill without a date of receipt, notify your supervisor. Key total amount of the bill. These will not always be requested, and should be entered only if present on the bill. The authorizing initials will be those of an individual in the office who has reviewed the bill and has authorized the dollar amount. The following information must be entered for each line item on the bill.
A bill may contain from one to line items. Continue keying line items until all line items for that bill are entered. If the date is incorrect, type over it. Not all bills require procedure codes. Up to eight characters may be entered. The first five characters are for the base procedure code, the next two are for the procedure code modifier, and the final character is for the fee schedule appeals code.
If a five-digit CPT4 code is followed by a one- or two-digit modifier this will not occur on a majority of the bills , that should be entered next, followed by a one-digit fee schedule appeals code this will be present only rarely and will have been written on the bill by other office personnel.
If no procedure code is required, no units are required. Key the number of units on the bill for the particular procedure up to three digits. The user should ensure that the number of units keyed is correct, because errors in the number of units result in misapplication of the fee schedule.
Valid codes are 1, 2, and 3 for BILL Bypass Code 1 may be keyed without being present on the bill if a multi-page bill is keyed as separate bills, and line items appearing on separate pages would be considered as duplicate input by the system but they are not. Valid codes are A through N. Most of the time, the balance at the bottom of the screen will be 0 when the entire bill has been keyed.
If the bill is out of balance, that is, the sum of the line item charges less ineligible amounts does not equal the bill total, a negative or positive amount will appear as the bill balance. If the bill is in balance, an "OK?
If the bill is not in balance, the system will produce this message and ask whether or not to continue. After checking to ensure accurate data entry, respond "Y" or "N". If the response is "Y", the system will give a final OK? At the final "OK" prompt, if the response is "N", the cursor returns to the case file number of the bill being keyed. BILL is used to enter data concerning manual bill payments, and to enter adjustments to bills previously paid.
The following information supplements the User's Manual. There may be as few as one bill in a batch. The bill batch identification number must remain unique within the weekly cycle. Government Transportation Request. For other adjustment transactions, the adjustment date is the date of the action by Treasury check deposit, check cancellation, or fund transfer. Key month, day and year as shown underneath Provider information on bill. If authorization initials are required due to the service date being prior to the history purge date, cursor up to AUTH field.
The system will allow up to four charge items per screen format. The charges must balance with the total. If there is an entry error, use the up cursor to move to the erroneous amount and make the correction. To adjust an entry to correct payment histories for data entry errors made when entering check cancellations, manual payments, fund transfers and cash receipts, use BILL The first entry after the batch number is the adjustment type of the record that is being corrected manual payment, fund transfer to agency, cash receipt, and check cancellation.
After that, data entry is identical to BILL BILL is used by bill resolvers either fiscal or claims staff or a combination of the two to bring bills which have suspended for review from BILL to a final disposition. After approved bills are transmitted to the Central system, they are subjected to a variety of processes.
One of these is a check against the Central bill history and against bill input for possible duplicate payments. Even though the BILL edit process checks for duplicate payments, because the data file BILL uses is less complete than the Central bill record file, and because BILL does not check against same-day input, it is possible for bills to pass through BILL but be rejected by the Central system because of possible duplication.
The purpose of BILL, Resubmit Duplicate Bills, is to allow an office to review records rejected by Central, determine whether the bill is in fact a duplicate of a previously paid item, and if not, enter a bypass code as appropriate and retransmit the bill.
BILL allows the offices to save time by eliminating the need to rekey and re-resolve rejected bills. The time frame for using BILL is limited to 12 days from the date of transmission of the original bill.
Bills which have not been corrected within 12 days may no longer be accessible using BILL, unless another bill in the same batch remains suspended. Thus if a bill has been rejected by Central as a duplicate and it is in fact a duplicate, the office does not need to take any action. If a bill is payable but is not corrected through using BILL before the full record is deleted, it must be completely rekeyed.
To use BILL , choose option 16 from the FECS Bill Payment Menu, then enter the batch identification number up to six characters , bill identification number up to three numbers , and line item number up to four numbers of the record which is to be reprocessed. After entering the batch ID, bill ID, and line item number, if the record is available for resubmission, the bill information will appear on the screen.
The user can then enter and verify a blank, or bypass codes 1, 2 or 3. Its most frequent use is to transfer bill payments made on a duplicate case to the file number of the case which is to be retained. The payee number correction could be used if a payee was entered in the provider file with an incorrect tax identification number, and a payment was made using the incorrect information.
Once the provider file record is corrected, the erroneous bill record can be corrected using BILL This job is used to add, modify, or delete records from the Provider Master File v For each provider, the following information is present in the file:name, address, including state and zip code, provider type code see PM Chapter , an exclusion flag, a payment flag, tax identification number either Employer Identification Number [EIN] or Social Security Number , sequence number, frequency of payment number, date of last payment, district office information, and date of last change.
Payment or denial of payment through the BPS cannot be made unless the provider is on the provider file, except by manual payment. Changes to the provider file may only be made by an individual or individuals who have been authorized to perform this function. The individual who performs the updates must be an employee of the Department of Labor as opposed to a contract employee and must not have any other association with processing bills through the BPS.
In other words, individuals who key, resolve, authorize, or audit bills should not be given permission to perform updates to the provider file. To add a record , in addition to the provider identification number and zip code, the user must enter the full name, street address and city, the two-letter abbreviation for the state, a provider type code see Chapter , a payment flag Y or N - see below , and district office information optional.
The system assigns a sequence number. Special characters , such as ". The payment flag should be "Y" for "yes", unless the district office has excluded the provider from payment under the provisions of 20 C.
The individual performing provider file updates is responsible for checking the excluded providers report or on-line query before entering a "Y" payment flag for any provider. On occasion, the district office may wish to set the payment flag to "N" for "no" for some other reason, such as the need to manually review all of a provider's bills. When adding providers to the provider file, the user must be careful not to make an addition which varies only insignificantly from a record which is already on the file.
Provider type codes determine the type of editing that will be done on a bill, including application of the fee schedule. The user must therefore be certain to enter a correct provider type code.
This function allows users to obtain immediate information concerning paid and denied bills. The information is displayed for individual case file numbers.
The records are displayed in order of date of service, with the most recent first. Each record displayed represents an individual line item on a bill, rather than the entire bill.
If a bill contains several line items, these will not necessarily be displayed sequentially on the screen. The up and down cursors may be used to move from one record to another. As the cursor moves, the display at the bottom of the screen changes. The following information is displayed on the screen for each record:. This is the tax identification number of the payee. For other types of claimant reimbursements, the provider number is shown.
Provider type code. If a provider type code is followed by an "R", the record was processed as a reimbursement to the claimant. If a particular provider type code was specified in the selection process, only 9. For instance, if "P" is selected, all records with provider type codes of P and PR will be displayed. Dates of service. If a date range for the search was specified in the selection process, only the records which contain "from" or "to" dates within that range will be displayed. Procedure code.
The procedure code, including modifier and fee schedule appeals code if applicable is shown. If the provider type is one which does not require a procedure code, the space will be blank. Charge amount. The amount billed for the particular dates of service and procedure is shown. Paid amount.
This is the amount paid for the particular dates of service and procedure code. If this amount is equal to the charge amount, and the check date see paragraph g below is blank, the bill has been processed during the current cycle, and the amount of the eventual payment is not yet known.
Once payment has been processed by the Central system, the amount will be updated. If the bill was paid paid amount does not equal zero , the date of the check by which it was paid will appear here. If the bill was denied at the Sequent level, the date of the denial will be displayed. If the bill was rejected by Central, a rejection code will be displayed. These codes and their definitions are as follows:.
If payment was made, this will be blank. If the bill was denied at the Sequent level, the two highest priority EOB message code numbers will appear code numbers consist of three numbers. If the record was rejected by the Central system, the date of the rejection will be shown. Record type. The record type reflects the type of record displayed. A sequence number of ZZ means that the record was processed as a reimbursement to the claimant.
BILL is used to request an overnight Central bill payment history for a particular case. When a history is requested, a report is printed the following work day, if the request was made before history requests were transmitted to the Central system. The history report contains information on bills which have been transmitted and accepted by Central only, including adjustments. Denied bills will not appear on the Central history report, since they are not transmitted to Central.
Bills rejected by Central will not appear on the report. A request can be made on a case by case basis for the bill payment history for a specific provider, a specific provider type, specific dates of treatment, or the complete bill payment history. If the history is requested during the week, bills paid since the Central history purge date usually two years will be shown on the history report.
If the history is requested on a Friday, all bills on the BPS, both active and purged, will be shown on the report. Suggested Usage. BILL may be used whenever a complete bill payment history is required for a particular case. The information contained in the report is more detailed than the information found in the on-line bill payment history, and covers a longer period of time. The report is particularly useful for determining third party disbursements, for determining actual payments when the on-line history is inaccurate, or for obtaining history which predates the on-line history.
To use this function, both a provider identification number and a provider zip code must be entered, and the entry must be done on a Friday. Provider Inquiry is used to determine whether a particular provider is on the Provider Master File. Since it is a query only function, it may be used by individuals who do not have access to the provider file via BILL Batch locator, option 09 under the bill payment menu, is used to determine the current status of bill batches.
It shows all open, closed unedited , and transmitted batches. It is often accessed just prior to running the bill batch edits to determine whether all completely keyed bill batches have been closed. This function, option 11 under the bill payment menu, shows open batches, and unedited closed batches, and allows the user to enter a batch identification number for opening, closing, or deletion.
Access to this option should be very limited. Provider Labels, option 12 under the Bill Payment Menu, allows the user to generate a mailing label for a specific tax identification number. The user can generate a label for a particular sequence, all sequences under one zip code, or all sequences and all zip codes.
This option, which is item 13 under the Bill Payment menu, provides a variety of means to view bills which have not been finalized. Bills with the following status codes may be viewed:. K - keyed, but the batch in which it was keyed has not been closed; N - keyed, but not yet edited by the BILL program; S - suspended for resolution; R - set to recycle through the BILL program by a bill resolver; I - internally denied bill; D - bill has been denied as soon as daily transmission takes place, bill is not accessible through suspended bill query, but instead appears in the on-line history ; and C - bill has been approved or partially approved for payment as soon as daily transmission takes place, bill is not accessible through suspended bill query, but instead appears in the on-line history.
Users may specify the query by case file number, batch identification number, provider number, or bill status code. After specifying the parameters of the search, a list appears of all bills fitting the search criteria, with a count.
The user may then select a bill for viewing. The screens are very similar in appearance and function to those in the suspense resolution program, except that no updates are possible. A data file on the Sequent contains a list of zip codes and the associated state codes. This data file is updated periodically.
Zip code search may be used to determine what state is considered valid by the system for a given zip code. ICD-9 codes are frequently found on medical bills, and are also used to designate accepted conditions in cases. Locate ICD-9 Code - the user enters a specific code, and the screen displays the code and the correlating description;.
Locate ICD-9 Codes by IC Code Range - the user enters beginning and ending ICD-9 codes, and the screen displays those codes and all the valid codes that fall in between, with the corresponding descriptions;.
Locate ICD-9 Code by Description Prefix - the user enters the first word of a condition description, and the screen displays all descriptions which start with that word, with their ICD-9 codes.
This option is particularly useful to claims examiners who know what condition they want to accept, but don't recall the ICD-9 code for the condition. This program enables the user to query the excluded provider file by name or by tax identification number.
After entering the data, the screen displays the full name and mailing address of the provider, the sanction and notification dates, and the source of the exclusion. When the name query is used, all records with names beginning with whatever is entered will be displayed.
For example, if "BROWN" is entered, all records with a last name of "Brown" will be displayed, but in addition, records with names such as "Brownlee" and "Browns Medical Supply" will be displayed as well. This chapter provides guidance and instructions for processing appeals of medical fee schedule determinations and adjustments to erroneous bill payments. Fee Schedule Appeals. Under 20 C. Only three circumstances will justify reevaluation of the paid amount.
These are:. The presence of a severe or concomitant medical condition made treatment especially difficult; or. The provider possesses unusual qualifications, beyond Board-certification, in a medical specialty. The provider must submit evidence to support the request for reconsideration of the paid amount. The Federal Employees' Compensation FEC district office DO servicing the claimant's case is responsible for processing the provider's request for reconsideration of the fee determination.
District Director DD. The reconsideration decision is to be prepared for the signature of the DD. Regional Director RD. If an appealed amount continues to be disallowed by the DO, the provider may seek further review. A decision from this further review, stating whether or not an additional amount is to be allowed as reasonable, is to be made within 60 days of receipt of the request for review.
This decision is to be prepared for the signature of the RD. Processing Fee Appeal Requests from Providers. In order to appeal a payment, the provider may, within 30 days of the date of payment, make written request for reconsideration of the fee determination; identify the procedure s in question; attach documentary evidence relevant to the circumstances upon which the appeal is based Paragraph 2, above ; attach a copy of the RV; submit the request to the Central Mail Facility CMF.
All appeals are logged and linked to the bill that prompted the appeal. The Claims Examiner CE who receives the thread should notify the DD that a new fee schedule appeal has been received on a case. The designated person s in the DO reviews the appeal request and either approves or denies the appeal or requests more information; this person should also reply to the thread.
Any additional information that is requested should be sent to the CMF for imaging into the case record. When a bill is in an open appeal status, duplicate bills for the same service are denied.
The Fee Schedule Appeal Reviewer. The person s to be charged with the responsibility of processing fee schedule appeals is left to the discretion of the DD and RD. However, when an appeal is made to the regional level, the person handling the appeal must be someone other than the person who processed the earlier appeal. Evaluating a Fee Appeal Request. The reviewer should consider the following:.
In addition to the evidence submitted on appeal, review any medical reports of record pertinent to the service or procedure in question. If it is not furnished by the provider, the reviewer may wish to review the original bill in the SIR system for the description of the service provided.
Severe or Concomitant Medical Condition. The evidence submitted, along with pertinent medical evidence which may already be on file, must establish the presence of a severe or concomitant medical condition and show that this condition made the billed treatment especially difficult.
As examples, cardio-pulmonary problems or severe diabetes may make treatment e. However, the mere fact that a severe or concomitant condition was present should not result in additional payment without regard to the service or procedure in question. For example, it would not be expected that difficulty in treatment would warrant an additional payment for an office visit or the taking of x-rays.
Any evidence used as a basis for finding that a severe or concomitant medical condition was not present or did not make the billed treatment more difficult must clearly and convincingly represent the weight of the evidence.
Such "conflicts" of opinion as to whether or not a severe or concomitant medical condition made treatment especially difficult are not subject to resolution by the use of an impartial third physician. Unusual Provider Qualifications. The evidence upon which such a decision is based is the provider's curriculum vitae. Board certification in a medical specialty is not, by itself, sufficient evidence of unusual qualifications.
Professorial rank or the publication of articles authored or co-authored by the provider which are pertinent to the medical condition or procedure in question are considered evidence of unusual qualifications. Additional Amount Payable. Where it is determined that an additional amount is payable, the DO is generates a letter informing the submitter of the approval.
The reviewer must prepare a memorandum for the file stating the findings and the basis for the approval of the additional amount. Second review and approval of this memorandum by a higher authority is not required, but may be implemented by the DO if desired.
Where additional payment is denied, the provider must be furnished with a letter decision concerning the findings and the reason for the denial. Denial of Appeal Payment. Where additional payment is denied at the DO level, the letter decision must contain a notice of the right to further review similar to the following: If you disagree with this decision, you may, within 30 days of the date of this decision, apply for additional review.
Where additional payment is denied at the regional level, the letter decision should advise the provider that this decision is final and is not subject to further review. The MBPC will then make the adjustment, issue a remittance voucher and update the system with the new data. Where an additional amount is found to be payable based on unusual provider qualifications, the DD should determine whether future bills for the same or similar service from that provider should be exempt from the fee schedule.
If so, procedures for "Provider on Review" should be followed. See paragraph 18, below. Adjustments: Correcting Errors Without an Appeal. Obvious errors warranting additional payment, identified internally or by contact from the claimant or provider, may be adjusted by the MBPC without following the formal appeal procedures. Submission of Adjustment Requests. The claimant should write "Corrected Bill" or "Adjustment" at the top of the form.
If either of these is submitted, a written explanation as to what needs correction must be included. A provider who requests an adjustment should submit a copy of the original bill with the original TCN, an explanation of what needs to be adjusted and a copy of the RV. At the top of the original bill, the words "Corrected Bill" or "Adjustment" should be written.
A letter sent to the MBPC at the CMF will also be accepted for adjustment as long as the information described above is included in the letter. Adjustments Based Upon Eligibility.
If the adjustment is for an eligibility reason, iFECS should be updated to reflect the current case status and accepted condition s. Once case eligibility has been updated, an adjustment request form should be completed and forwarded. The adjustment will be processed at that time. Authorization Issues. If the adjustment is related to an authorization issue, the treatment suite will be reviewed to determine the authorization level.
If an authorization is required for the service, the MBPC will review the authorization subsystem to see if an authorization has been created. If not, the CE will be notified via the Omnitrack system. Types of Adjustments. There are several types of adjustments. A bill credit void is a reversal or offsetting of a previously paid bill.
An adjustment is a net change to a previously paid bill as opposed to a complete reversal or credit. Adjustments may be necessary for a variety of reasons, although they usually involve some error in provider reimbursement.
Gross adjustments are those paid to a provider and may include multiple claim numbers. An example of a gross adjustment would be if a provider was incorrectly enrolled as a chiropractor. All of his bills have denied for that reason. Once the enrollment status was corrected, the MBPC would make a one-time payment to the provider for all bills denied due to the incorrect enrollment status.
Gross adjustments are special cases and it is preferable to adjust specific bills when possible. Mass adjustments and credit transactions are submitted online. An example of a mass adjustment is the correction of bills paid based on an error in the fee schedule. The mass adjustment process should be used cautiously due to the potential impact on the processing system since large numbers of bills may be affected.
Provider Billing Claimant for Full Payment. The claimant does not have the right to appeal the fee determination per se. However, under 20 C. Where the claimant has made payment to the provider and is only partially reimbursed due to the application of the fee schedule, the DO should release a letter to the provider, with a copy to the claimant, which:.
A sample letter is shown as Exhibit 2. If, after receipt of the above letter, the provider appeals the fee determination and it is found that no additional amount is payable, the letter decision should again request that appropriate refund or credit be made within 60 days.
Where the provider has initiated collection action, or has actually collected from the claimant, an amount in excess of the maximum allowable charge paid by the Office, the DO should release a letter similar to Exhibit 3 to the provider, with a copy to the claimant, requesting that the amounts in excess of the maximum allowable fee which have been collected, be refunded to the claimant or credited to the claimant's account, or that the provider cease attempts to collect such additional amounts.
The provider should be given 60 days to comply. If the provider does not comply with the written request of the Office within 60 days, the DO should contact the provider to make appropriate refund or credit, or to cease collection action. If this contact does not satisfactorily resolve the problem, action should be taken to exclude the provider from participation and payment under the Federal Employees' Compensation Act FECA. See PM Where all efforts to have the provider credit or refund to the claimant an amount the claimant paid the provider in excess of the maximum allowable have failed, the DO should reimburse the claimant for the amount paid in excess of the maximum allowable fee.
See 20 C. Return to Provider Letter and Remittance Vouchers. This letter contains specific information explaining why a bill was returned. It is most commonly sent to the provider, but may be sent to a claimant if a request for reimbursement has been submitted improperly.
The reason for the returned bill is noted on the letter. The erroneous bill is attached to the RTP letter. All information cited must be corrected before the bill can be processed.
This is not a formal decision and no appeal rights are issued with this letter. Remittance Voucher RV. They are issued separate from the actual payment.
Appeal rights are included on RVs where bill s have been reduced or denied. This number is different from the RV number; the check reference number will appear on the RV. This number should be referenced when inquiring about a specific payment. Adjustments will always result in two TCNs, one crediting the original bill and the second processing the adjustment.
Additionally, you can automatically crop in around the stones on the board for a partially occupied board - problem setup, joseki, etc. To get out of this mode just uncheck Manual and continue to browse and edit while zoomed in. This can be thought of as variations of the root node. Also on the File menu you may choose Open Record You can choose to Save Record Normally, tapping the board will navigate if appropriate. You can, of course, also add stones to the board for setup, and add board markup.
Finally, you can annotate the position e. Good for White or move e. Interesting Move. Annotations are displayed in the comment field but this saves you typing, makes the record smaller, and can later be localized into other languages. These are the standard SGF annotations but I plan to introduce a bunch more in the future. You can edit node info and game info which is displayed in the title bar and comment fields but again is a standard way to record this infomation for compatibility with Go databases, etc.
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