Just out of curiosity--if any one here happens to know something. Our auditor is taking a four-day weekend and I'm impatient. (I'm not an Inpatient--maybe I need to call an ODDitor)......
I am going through 835 files from Medicare to figure out some data extraction issues. Came across two things that seem odd (but don't interfere with my assignment).
1. This month, many of the claims have remark codes MA44 and MA01 or MA02. In 2005, ALL claims were this way. What's odd is that both MA01 and MA02 translate to variations on "You have the right to appeal." But MA44 translates to "No appeal rights. Adjudicative decision based on law." These codes are in the MIA segment, which applies to the whole claim and not to any specific adjustment or service.
2. In general, "Per Day Limit" (AMT02 when AMT01 is "DY") is either a reasonable dollar amount or is not present at all. But. on every claim (and only these claims) where "Reimbursement Rate" in MOA01 is .47 (46%), the "Per Day Limit is also .47 (47 cents).
--
Wes Groleau
I am going through 835 files from Medicare to figure out some data extraction issues. Came across two things that seem odd (but don't interfere with my assignment).
1. This month, many of the claims have remark codes MA44 and MA01 or MA02. In 2005, ALL claims were this way. What's odd is that both MA01 and MA02 translate to variations on "You have the right to appeal." But MA44 translates to "No appeal rights. Adjudicative decision based on law." These codes are in the MIA segment, which applies to the whole claim and not to any specific adjustment or service.
2. In general, "Per Day Limit" (AMT02 when AMT01 is "DY") is either a reasonable dollar amount or is not present at all. But. on every claim (and only these claims) where "Reimbursement Rate" in MOA01 is .47 (46%), the "Per Day Limit is also .47 (47 cents).
--
Wes Groleau