CLIENT UPDATE
2017
David Loveless
Account Manager Start Date: Best part of working at UCS: Strengths:
Weaknesses:
Favorite TV Shows/Movies:
2
David Loveless (aka Ulysses S. Grant Lookalike
Pets:
Hobbies:
Favorite Quote or Life Motto:
Role Model:
Favorite Food & Beverage:
Weirdest thing that ever happened to you:
Biggest Regret:
What cartoon character do you relate to most & why?
3
Ambulatory Surgical Center & Substance Abuse Facilities
SOLUTION SHOWCASE Utilizing the expertise of our Certified Coding and Medicare Repricing Teams to review these claims, UCS has developed a response that provides dramatic savings and allows health plans to comfortably walk away from unreasonably high charges with confidence. Understanding that appeals and additional payments are likely to accompany the process of reducing these costs, UCS has created a specialized team which responds in a timely and professional manner. Assuming the roles of appeals manager, negotiator and payer of additional charges, the UCS solution removes the health plan from further noise, energy and liability. ► Pricing based on proprietary algorithms with savings of 50% - 90%. ► Includes nurse bill review & edits. ► UCS manages all provider inquiries to resolution.
Our Guarantee:
UCS will support and guarantee all of its savings on Ambulatory Surgery Center claims, as well as Substance Abuse Facility claims related to drug, alcohol rehabilitation, detox, residential care and group therapy. This includes appeals management, legal assistance if needed and any additional payments to the provider required to settle the matter.
4
Identifying Ambulatory Surgical Center & Substance Abuse Facility Claims
CHECK YOUR CLAIMS! Luckily, we guarantee these!
Ambulatory Surgery Center Claims Bill Form UB HCFA
Indicator
Bill Type will be 0831 or simply 831 Procedure will be followed by a Modifier "-SG"
Substance Abuse Facility Claims Bill Form UB
Bill Types
Begins with: 11*, and 131, 132, 761, 762, 851, 852
AND/OR include Revenue Codes as follows:
AND/OR include CPT Codes as follows:
AND/OR include HCPC Codes as follows:
Revenue Codes
CPT Codes
HCPC Codes
0116 0118 0148 0905 1002
0138 0146 0901 1001
0204 0529 0945 0136
0912 0944 0128 0158
1004 0126 0156 0910
90785 90845 96120 90849 96152 90870 96155
90840 90887 90832 96102 90836 96110 90839
90880 96119 90847 96151 90865 96154 90876
96118 90792 96101 90834 96105 90838 96116
99355 90846 96150 90853 96153 90875 99354
G0176 S9485 T1006 T1007 T1023
G0411 G0177 G0396 G0397 G0410
H0001-H2037 G0422 G0443 G0444 G0445
S0201 S9475 S9480 S9482 S9484
Substance Abuse Facilities
Ambulatory Surgical Centers
UCS Savings % VS PPO Savings %
UCS Savings % VS PPO Savings %
74%
90791 90899 90833 96103 90837 96111
47%
56% 5
25%
Why you may want before banging your When is a bump on the head just a bump on the head and not something more serious? What is a “closed head injury”? What is a concussion? Just the facts… The brain sits in a confined space. The brain has a consistency similar to gelatin. In a closed head injury, sudden impact to the head which knocks the brain against the inside of the skull. This is a traumatic injury and: • can diffuse and affect many cells and areas of the brain • can be focal and affect an area of the brain Common causes of a closed head injury include motor vehicle accidents, assault, falls, work related accidents and sports. However, there are uncommon causes as well. Closed head injury can occur from shifting luggage in overhead bins on aircraft, unsecured items in tall cabinets, walking into a structure (happens frequently with the use of smartphones) or when there is other impact to the head. Concussions are difficult to recognize because there is no visible injury to brain structure. A concussion is identified from the various symptoms. While most sports related concussions do not require emergency care, medical evaluation is necessary. An injured person needs to be closely observed for a few days. In 90% of concussive injuries, the person does not lose consciousness. The following symptoms may occur: • Feeling dazed or stunned • Headache • Confusion • Nausea or vomiting • Memory loss • Double or blurred vision • Light or noise sensitivity • Loss of balance or coordination • Difficulty concentrating/frustration • Change in sleep patterns • Irritable/emotional/sadness • Perseverating (asking the same question over and over again)
6
to think twice... head on your desk... The injured person should not return to sports or hazardous activities until a healthcare professional confirms medical recovery. This helps prevent second impact syndrome. Second impact syndrome is a second concussion that occurs before the first concussion is resolved. With a second impact, the brain injury may be compounded or become permanent. (Concussions are known to be cumulative.) Most people who sustain a concussion are back to normal in 3 months. Some people can have long term problems with memory and concentration. There is no single definitive test that confirms a concussion. The physician will integrate several tests and consider the mechanism of injury. A CT scan will rule out a sull fracture or neck injury. The physician will also perform a neurologic test. Examples are below: • Memory questions: What day is it? Where are you? Who are you? How did the injury happen? • Give the person 3 things to remember (numbers, objects, colors). Ask the person to repeat within 5 minutes. • PERRL check: Are the Pupils Equal, Round and Reactive to Light? This is the test the medical professional performs when shining a light in the eyes. The pupils should constrict and get smaller with bright light. Unless there has been surgery (with cataract surgery, the pupils will be dilated, glaucoma surgery may result in an abnormal pupil shape), the pupils should be equal and round. • Coordination test: Bring the finger to the nose, hold arms in front of the body evenly with the eyes closed. If one arm drifts downward, the test is abnormal. • Gait evaluation: Can the person walk heel to toe/walk normally, etc. Great & Interesting Alternatives: You can’t always avoid getting a concussion during sports, automobile accidents and the like, but you can avoid the self-inflicted concussion brought about by banging your head on your desk at work. Here are a few other options you may want to try to relieve your stress and frustration at the office.
The Ostrich Pillow
Get a Bonsai Tree!
Pet a Puppy
(not just for Mr. Miyagi)
7
Go Shoeless
(check for odor first)
Happenings Employee Birthdays: March 3: Patty Kreuzer, Issue Resolution Claim Specialist March 7: Joshua Carder, President March 7: David Loveless, Account Manager March 14: Dwight Adams, Senior Negotiation Analyst
Anniversaries:
March 16: Lisa Schnepp, Claims Editing Analyst 2-Year Anniversary
UCS Live Chat: Now Available! Have a quick question that isn’t claims related? Simply visit our website at www.UnitedClaimSolutions.com and click the “Start Chat” button! You will be directed to a support agent that is happy to help! We will do our best to get your request taken care of quickly & accurately!
8
Client Contest
Tell us why you feel LUCKY to have UCS as your Cost Containment partner! What you’ll win: • $25 Gift Card • Pot of Gold
Please specify whether or not we can share your testimonial with fellow readers! Names & organizations will not be shared.
Email your submissions to: Amanda Hertig Marketing Specialist ahertig@unitedclaim.com
February Facebook Winner
Karen Niemeyer - $25 VISA Gift Card
9
23048 N 15th Ave Phoenix, AZ 85027 (866) 762-4455 www.UnitedClaimSolutions.com