| December 18, 2003 - CHARTS Notes |
Notes to
December 18, 2003, Patch008
This update contains modifications: 1) To Check and modify invalid ICD9 codes, 2) To test for HIPAA Medicaid Compliance, 3) To set your Medicaid Co-insurance rate for 2004, 4) To optionally write off Part B charges for 2004, and 5) A revised version of the Census program.
Table of Contents
Please print this page.
Overview: Throughout the years the diagnosis codes were refined. When testing for HIPAA billing compliance Medicaid flags any diagnosis codes that are no longer valid. Since HIPAA requires that both the admitting diagnosis and the current diagnosis appear on each bill, the items flagged may become an issue.
We have therefore developed a diagnosis crosswalk file that can be used to convert invalid diagnosis codes to valid ones. This crosswalk file is based on our experience in testing thousands of claims, but it is by no means complete. Some diagnosis codes have been refined to multi-levels and it is only you, the user who can decide which ones are appropriate.
For example: Diagnosis 277.8 is now sub-divided into 5 codes, 277.81 - 277.84, and 277.89.
To update the diagnosis in your Diagnosis Table file and in your Resident and Activity files do the following:
From any CHARTS menu type SY and press ENTER.
Type 1 to Change Records.
Type 15 for Additional Items.
Type 15 for Additional Changes.
Type 14 to Update diagnosis from crosswalk.
Before processing, make sure no users are accessing the resident file (including MDS). The time it takes to run this program varies based on your server and the number of records.
Press ENTER to begin the process.
2. Testing for HIPAA Medicaid Compliance
The adjustments that you need to make to various table files PRIOR to Medicaid HIPAA testing are described in Letters Sent to Clients dated November 12, 2003.
After your Medicaid charges have been posted and sent to Medicaid (the old way) they should be sent again for HIPAA testing in the new HIPAA format as follows:
From any CHARTS Menu type AR and press ENTER.
Type 3 for Print Bills and press ENTER.
Type 2 for Print Medicaid Bill and press ENTER.
Type 12 for Medicaid Part I - HIPAA and press ENTER.
Select the appropriate Medicaid type(s) and press ENTER.
The following screen appears:
MEDICAID BILLING HIPAA
From Patient: Ä▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬ To Patient: ZZZ▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬
<--- Record Type ---> <------ Types to process -------> <-- Billing Media -->
Reg: Y Void: N Adj: N Client pended: N No MA#: N BHR: Y T-tape D-diskt : D
Print option: P
Billing Date: 12/16/03 Provider no.: 00340845▬▬▬▬▬
Primary Payer ID: 141797357
│ Process Current Charges: Y │ Process Outstanding Charges: N │
│------------------------------------│---------------------------------------│
│ Date Range : ▬▬▬▬▬▬▬▬ ▬▬▬▬▬▬▬▬ │ Range of Dates : ▬▬▬▬▬▬▬▬ ▬▬▬▬▬▬▬▬ │
│ Bill Rebill All: R Rebill from: ▬ │ Bill Rebill All: B │
│ D-Dskt.P-Paper │Rebill'IF'billed on: ▬▬▬▬▬▬▬▬ ▬▬▬▬▬▬▬▬ │
│ │ │
Sender-id: 123006785▬
Serial Number: 033500
Receiver Code: D FILENAME LIBRARY VOLUME SIZE
Last invoice: 100011530 MDCAID▬▬ TAPELIB▬ VOLB▬▬ 00100
Non Billable BH Code: ▬▬ Therapeutic: ▬▬ Last Revised: December 18, 2003
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Complete the Date Range and be sure to type R at Bill Rebill All.
Press ENTER.
When the program completes type 13 for Medicaid Part II - HIPAA and press ENTER. The following screen appears:
HIPAA - Medicaid Billing
Table File Name for Submitter Information: ▬▬▬▬▬▬▬▬▬
File: ▬▬▬▬▬▬▬▬ Library: ▬▬▬▬▬▬▬▬ Volume: ▬▬▬▬▬▬
Diskette Device Address: ▬▬▬ Test or Production (T/P): T
Print Option: S Taxonomy Code: 247RG0300X
Last Revised: December 18, 2003
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The device address entered above determines where the test files is created. As of release version 12/16/03 the name of the Medicaid HIPAA test file is MEDHIPAA.
Go to HIPAA test site at www.nyhipaadesk.com and follow instructions for 837I transactions.
3. Your Medicare Co-insurance rate for Year 2004 has been set.
This update sets your Medicare Co-insurance rate for 2004 to $109.50.
If your 2003 table for co-insurance is set-up so that specific HMO billing types have different co-insurance amounts, then the 2004 table must also be modified for the HMOs. This table file can be found at CTF, 8, 7. Specify '04' for the Main Key.
4. Writing Off Part B Charges for 2004 (Optional)
Overview
Note: Do not implement the steps outlined in this section until your December 2003 Part B Charges are posted.
Abstract. Effective December 8, 2003 the Physical Therapy, Occupational Therapy and Speech Therapy limits that were in effect since September 2003 have been discontinued. The software has been undated to take this change into effect. We have also modified the create UB92 bills program to bill as a default all Part B charges, even written off charges because as of the date of this release it is unclear if Medicare will pay for Part B services rendered between September 1 and December 7 that are over the limit if billed after December 7, 2003.
Several of our clients, with the implementation of the September Therapy cap have chosen not to write off their Part B charges. The documentation below is intended to illustrate now to go back and write off all Part B changes at the point the charges are posted. If to do not desire to write off your Part B charges or you did not switch accounting methods in September, you can disregard this section.
Modifying the PART B Ancillary Table to Write Off Part B Charges
| 1. | From any CHARTS menu type CTF and press ENTER. |
| 2. | Type 8 for Accounts Receivable and press ENTER. |
| 3. | Type 2 for Ancillary Billing Types and press ENTER. |
| 4. | At Main Key type PB and Press ENTER. (Some facilities use PARTB as the Main Key) |
| 5. | Verify that the Contractual Allowance Write-Offs are set as indicated below: |
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ANCILLARIES BILL TABLE Enter Main Key : PB Secondary Key: PART B Description : MEDICARE PART B Bill Receive Send Bill & Send Bill Contractual Allow Write Off If Type From to to Receivable Write Off In Elig Part B Medicaid S___ PB__ N Y Medicare S___ NB__ N Y N Private S___ PB__ N Y N VA S___ PB__ N Y N Other S___ PB__ N Y N Bedhold S___ NB__ N Y N *PB = Part B **C = Co Insurance Provider Enter (F) To File (I) To Ignore: F |
| 6. | Press ENTER |
Re-Setting User Parameter Option.
You can choose how the system should handle co-insurance charges for the therapy
ancillary services.
From any CHARTS menu type,
NHOP or [UP, 11], press ENTER, and the following screen appears:
1. ▬ Using 8 Char UserID 21. ▬ No facesheet activty 41. ▬ Allow Check Reprint
2. ▬ Allow for RQ Delete 22. ▬ Default UPIN on UB92 42. _ Wisp NT System
3. _ > 24 Payroll Deduct 23. ▬ UB92 Hold If No MC# 43. ▬ MDS2 Lock Date
4. ▬ MC DEMO Pseudo Chrg 24. ▬ MDS+ Do Not Init RX 44. ▬ M2 no CP 30 day y/n
5. ▬ Dont Show SS# PR Ck 25. ▬ Use NPRINT to print 45. ▬ In PPS program
6. ▬ FS Overlay Option 26. ▬ Using Password 46. ▬ PPS - Urban/Rural
7. ▬ Sterling Bank CR Opt 27. ▬ PR Signature on Ck 47. _ Init Cond M2
8. _ Coins Ind for Copay 28. ▬ AP Signature on Ck 48. ▬ Accrl Hol Hr/Month
9. ▬ UB92 Release Info 29. ▬ PF Signature on Ck 49. _ Set PRI to "N"
10. ▬ UB92 Assign Benefits 30. ▬ Union Gross Option 50. ▬ YTD Deductions P/R
11. ▬ PostAncl C/I Default 31. _ Timeclock Option 51. _ PPS Part B C/I Opt 7
12. ▬ Pvtbl Include Allow 32. _ MDS2 Quarterly F/L/S 52. L=Lock,N=No Unlock
13. ▬ Project Co-ins Budget33. ▬ HMO - UB92 Type 53. ▬ M2 R&D Insert Zero
14. _ Rx Label Oxford tel. 34. ▬ UB92 Use AD Diags 54. ▬ Use Elig B rate(NY)
15. ▬ Disb Print Inv Date 35. ▬ Face Ovly 3rd Resp 55. ▬ M2 Sched from MDS
16. ▬ Overlay hp5 ind 36. ▬ P/R Print Rates 56. ▬ Anc-Use Rev Cd Rate
17. _ ADDPAT verify 37. ▬ Prompt Co-pay type 57. ▬ Anc-W/O $1500 Bill
18. _ Prompt Indvbill 38. ▬ Extra Contr.RateCode 58. ▬ Anc-Mult Trt to 1
19. ▬ Display RugIII rate 39. ▬ PF2 Bed/Discharged 59. ▬ Default hosp option
20. ▬ # of UB92 Diags 40. ▬ Check M2ADD Fields 60. ▬ RHS Reserved HIPAA
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Type a blank space above at option
51 _ PPS Part B C/I Opt
By setting option 51 above to blank you are indicating not to bill co-insurance.
The Census program [CC, 11] has been revised to allow for the printing of 12 month of census information. Simply enter in a 12 month range into the from and to date fields and separate reports for each month will be printed.
The Census program also has been updated to display the percentage of residents on bed-hold each day to assist the facility in determining if the facility can bill Medicaid for bed-hold days.