ubWATCH Process Central control, llc. UBWatch Process. Key Roles. Corporate Coding Specialist/Gatekeeper Accounts Receivables/Billing Corporate MDS Director . Corporate Coding Specialist/ Gatekeeper. Approves all therapy diagnosis codes Creation of Diagnosis sheets Primary sheets
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Central control, llc
Corporate Coding Specialist/Gatekeeper
Corporate MDS Director
Therapies on UB inconsistent with corresponding MDS
Correction: Review DOS; check therapy software to assure therapy was received compared to what is coded on MDS
Other diagnoses in the claim do not seem to be supported by the MDSs found
Correction: Review DOS, check physician orders, care plan, chart and if diagnosis is active, request MDS to review and code active diagnosis on MDS; if diagnosis is not active, will remove from diagnosis sheet
Admitting diagnosis in the claim do not seem to be supported by the corresponding MDSs found
Correction: Review admit diagnosis and if it relates to care. Suggest MDS review and if pertinent to care with documentation support, suggest adding to MDS.
Claim type and dates inconsistent with corresponding MDSs
Correction: Review DOS to assure MDS covers time frame
Admission date is greater than 30 days from qualifying hospital stay
Correction: Verify that we have code 78, on the occurrence span code, with correct dates on claim. Also, verify that we have condition code 57 on claim.
No corresponding MDSs for claim
Correction: Review DOS and assure MDS covers time frame in question. Sometimes this is noted when a discharge occurs right after an assessment was done. Validate that an assessment was done to cover DOS prior to discharge
Incorrect principal diagnosis coding for therapy claim
Correction: Add/Remove therapy codes from principal diagnosis OR add penny charges to the claim
Claim type and date inconsistent with other claims
Correction: Reload previous claims. Some claims are stopping in suspense and were never cleared; therefore, looking for original claim
Therapy services not justified by diagnosis on Part B claim
Correction: Check LCD for diagnosis codes that justify CPTs billed
Medicare contractors can create guidelines for certain services to determine if they are reasonable and necessary, and covered as a Medicare benefit.
No qualifying hospital stay before admission
Correction: Add the qualifying stay which was omitted on Census line