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UB04 Update
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Version 6.0
Effective: January 1, 2012
FL 44 Accommodation Rates are Not Used in 5010
Rationale: The rate can be computed by dividing the total charge by the number of units and therefore do not map to the 5010.
FL 43 Notes
To be consistent with the 5010 837, "ME" (Milligram) is a valid unit of measure qualifier for Medicaid Drug Rebate Reporting.
FL 63A, 63B, 63C
Redefinition and Restructuring of Data Element to include Referral Number.
UB04 Version 6.00 Clarifications/Errata/Updates UB04 Implementation Calendar |
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Payer Update
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United Healthcare
United Health Group internal business teams are updating internal processes to accommodate the CMS extended enforcement period and will NOT reject 4010 transactions until April 1, 2012. Per the original mandate, United Health Group will also accept transactions using the 5010 standards.
UHC Network Bulletin
UHC 837I 5010 Companion Guide
UHC 837P 5010 Companion Guide
UHC 835 5010 Companion Guide
Medicare Section 1011--News Alert! Highmark Medicare Services Ownership Change-On December 8, 2011, Highmark, Inc. and Diversified Services Options (DSO) announced an agreement for DSO to acquire HMS. The transfer of ownership is expected to occur on or about January 1, 2012.
Press Release here
Cigna
Changes Patient ID cards and adds new logo, along with HIPAA 5010 updates and new street address for Cigna International.
Network Newsletter
Triacare
Uniform Business Office News
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Medicare Quarterly News
Inpatients: 3 Day Window Policy
Effective: January 1, 2012
Implementation: January 3, 2012
CMS shall establish a new payment modifier PD (Diagnostic or related non-diagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days) and require that...read full transmittal below.
Effective: April 12, 2012
A clarification on the onset of dialysis adjustment for ESRD claims.
1. A revision to ESRD claims reporting the drug Vancomycin.
2. A revision to hospital reporting emergency related lab services.
3. A clarification of ESRD claims reporting the Kt/V value.
4. A revision to ESRD claim requirements for reporting hematocrit and hemoglobin readings for all ESRD patients.
MLN Matters MM7593
| Hospice Claims Processing Procedures for Face to Face Encounters Do Not Occur Timely
Effective: January 1, 2011 Implementation Date: January 9, 2012
If the required face to face encounter does not occur on time, the beneficiary is no longer certified as terminally ill, and consequently is not eligible for the Medicare Hospice benefit.
MLN Matters MM7478
Reporting of Recoupment for Overpayment on the Remittance Advice (RA) with Patient Control Number
Effective: January 1, 2012
Implementation:
Professional claims - January 3, 2012
Institutional claims - April 2, 2012
DME MAC's - October 9, 2012
Instructs the share systems to replace the HIC number being sent on the ERA with the Patient Control Number, received on the original claim. Only apply to the 0050101A1 version.MLN Matters MM7499
Determining Claims Processing Timeliness When Held Claims Are Later Subject to an ADR
Effective: April 1, 2012
Implementation: April 2, 2012
Medicare contractors shall exclude claims from claims processing timeliness calculations when both condition code 15 and 64 are present.
CMS Transmittal 976 CR7550
Correct Provider Billing of Admission Date and Statement Covers Period-Revised again!
For claims with discharge dates of July 2, 2011 forward.
The admission date (FL 12) is the date the patient was admitted as an inpatient to the facility.
MLN Matters SE1117
Discontinuation of Hospice Late Charge Claims
Effective & Implementation: April 2, 2012
Hospices may no longer submit late charge claims for services rendered on or after April 1, 2012. Hospices may adjust finalized claims to add late charges within the normal timely filing period as defined in the 'Medicare Claims Processing Manual, Chapter 1, Section 70'.
MLN Matters MM7556Medicare Payments for Diagnostic Radiology Services in Emergency DepartmentThey will pay for a second interpretation (which may be identified through the use of modifier 77) only under unusual circumstances (for which documentation is provided).
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Claims hung out to dry with RAC audits?
According to AHA:
Nearly 50% of all hospitals reported spending more than $10,000 dealing with the RAC program this quarter. See page 53.
71% of participating hospital reported that RAC impacted their organization this quarter and 50% reported increased administrative costs. See page 54.
Administrative burden of RAC is spread across all types of hospital staff. RAC coordinators spent the most time responding to RAC activity. See breakdown on page 56.
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AHA RAC Update Presentation
***CMS Recovery Audit Program MAC-issued Demand Letters Find details here
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Prevent 5010 claim processing problems. Contact the company that is built on integrity and thrives on industry challenges. We will respond to any type of customer request within 48 business hours.
Regards, Jayne Kroner, Editor
newsletter@ciriusgroup.com
www.ciriusgroup.com
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 | January Blood Donor Month
This video is certain to lift your spirits - from hospitals around the country. |
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1500 HIC Form
Reference Instruction Manual
Change Log
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Navigating 5010
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CMS Transmittal 966 CR7596 Coordination of Benefits Agreement (COBA) National Crossover Process
Non-Specifc Procedure Code Description Requirement
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On the Horizon
APR-DRG
Provider Resources available here for ICD-10 Conversion.
Find out here
ICD-10 Transition
CMS releases Claims Processing Guidance
CMS Transmittal 950 CR7492
MLN Matters MM7492
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Compliance Corner
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Standard Preparation and Administration of Drugs:
Interpretive Guidelines. According to the Institute of Medicine of the National Academies, medical errors are among the most common medical errors.
CMS Transmittal 77
CMS generates updated Quarterly Compliance Provider Report
Full report here
Medicare Claim Review Programs: MR, NCCI Edits, MUEs, CERT and Recovery Audit Program
Instructional brochure here
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Part A to Part B Rebilling Demonstration Outreach and Education First 380 hospitals that sign up may participate. This is a voluntary project that impacts claims denied by CMS auditors beginning January 1, 2012- December 31, 2014. CMS Presentation Enrollment application |
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