Dialysis Mystery Breakout

Mystery Breakout

Lost Revenue - Dialysis

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Welcome!

You're stuck in a maze of billing musteries. To escape, you'll need to solve each challenge and recover lost revenue. Your firt step? Head to the file index and choose your mission.

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Mission 1: POLICY PATROL

Locked

Locked

Locked

Click on the first file index to start the journey. The other missions are locked and will require a key to open.Complete the first mission to unlock the key to Mission 2. Along the way, you'll face questions and puzzles that must be solved in order to find the key and continue your escape.

Walk the streets to locate the storage room that holds important billing files. Correctly answering questions about billable max limits, LCDs, and medical policies will unlock the key to your next mission.

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Read the question in entirety and click the correct answer below.

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Your provider is billing for all dialysis treatment's (CPT 90999) received between January 1st and January 31st. How many days/units can the provider bill for the month without using a modifier?

Great Job! The billable max for dialysis treatment (CPT 90999) days/units is 14 for any calendar month with 31 days, like January. Click the green arrow to go left into the alley, where the storage room is located.

You've found the alley, but to unlock the storage room, you need to determine how many times the provider can bill the drug Aranep (HCPCS J0882) during dialysis treatment for the entire month of January.

Click the yellow link icon to access Novitas and review ESRD billing requirements. Once you reviewed the details, answer correctly to proceed.

15

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5

They are routed to Credentialing Workqueues in EPIC.

Great Job! The billable max for Aranesp (HCPCS J0882) units is 5 for any calendar month 30 or 31 days, like January. Click the green arrow to enter the storage room and find the key to unlock the next mission.

You see several file drawers in front of you, but only one holds the key to your next mission. The correct file cabinet will be the billable max for 90999 and J0889 for the month of January.

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Add both maxes for the month, this will be the number of the correct file drawer; click the correct file drawer.

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You Found the Key!Now return to the file index with your key to inlock the next mission.Click the Key to continue.

Click the key to leave the room and begin Mission 2!

Mission 2:COMPLEX CLAIMS

Completed

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Locked

The search continues! You've unlocked Mission 2! Your goal is to find the key that will unlock Mission 3.Navigate through this mission and solve the puzzles. Along the way, you'll need to reach a payphone, where answering the questions correctly will reveal a code. Use the code to unlock the safety deposit box that holds the key to Mission 3.

Amid the parked cars, trashcans, and street cones,you notice a piece of paper peeking out from under a cone. It looks like part of a clue that may help you reach the payphone.Drag the cone aside and click on the paper for a closer look!

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You've Arrived!You've made it to the payphone! To get the code, you will need to answer three questions. Answer correctly to receive the code that will help you get the next key.

The claim's payment will remain the same, as BMI does not affect payments.

The claim's payment will increase due to the additional nutritional services required.

Your patient has a BMI of 16 and requires additional nutritional support during dialysis. How will this impact the claim's payment?

The claim's payment will remain the same, as BMI does not affect payments.

The claim's payment will increase due to the additional nutritional services required.

Your patient has a BMI of 16 and requires additional nutritional support during dialysis. How will this impact the claim's payment?

The claim's payment will remain the same, as this type of diagnosis does not affect payments.

Your patient has a secondary diagnosis of Nephrogenic diabetes insipidus (ICD-10 N25.1) and requires ibuprofen during dialysis. How will this impact the dialysis claim's payment?

The claim's payment will increase due to the nature of the secondary diagnosis.

The claim's payment will remain the same,as body surface area does not influence payment.

Your patient has a larger body surface area, which requires more time/duartion of dialysis treatment.How will this impact the dialysis claim's payment?

The claim's payment will increase due to the additional time required.

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Remember the code

Click the key to return to the file index and unlock the next Mission!

Mission 3

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Completed

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Mission 4

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Completed

Wronganswer

Wronganswer

Rightanswer

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14+3

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Completed

Completada

Completada

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Completada

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Congratulations, you made it out!

Wrong answer!

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Identify which comorbidities qualify for additional payments and how they impact claim reimbursements.

Comorbidity Clue

K57.31

G93.2

L89.02

B26.1

H01.11

Incorrect!

Incorrect!

Incorrect!

Incorrect!

Correct!

Correct, K57.31 qualifies as an Acute Comorbidity and qualifies for additional payments. Using the letters E, S, R, D fill in the missing letters to reveal the next step:

_NT_ _ TH_ BLACK CA_ _OWN TH_ _T___T.