Page 2:  Medicare HIPAA 837 Version 4010 A1.

Page 3:  Using  WINPCACE Version 1.55.

Page 5:  $1,590  Part B Limit for PT and OT - Effective September 1, 2003.

Page 5:  Overview  

Page 7:  Resident Report Generator, PMGEN - new fields for PT and OT Amounts. 

Page 8:  Verify that your Part B charges are not being written off.

Page 10:  Enter your 2003 HCPCS rates.                                                       

Page 11:  Set-up for billing Co-insurance (optional). 

Page 15:  Using POSTANCL to enter Part B ancillary charges and co-insurance records.

Page 17: Federal, New York State and New York City Tax Tables

Page 2:  Medicare HIPAA 837 Version 4010 A1

This section does NOT apply to those clients using PC-ACE or WINPCACE.

Empire Medicare is requiring that all electronic submissions use HIPAA 837 Version 4010 A1 effective October 16, 2003.

(If you have not yet tested the 4010 included in our April 2003 release - please see frequently asked question P-3207 Submitting a HIPAA Test to Empire Medicare before preceding).

After loading the software please e-mail Sbenz@EmpireBCBS.com and inform her that you wish to be set up for 4010 A1 production. The e-mail should include the facility name and Medicare provider number. Submitting a test of the 4010 A1 using a few claims before e-mailing Empire Medicare is highly recommended but not required.

Page 3:  Using  WINPCACE Version 1.55

This section applies to those clients using PC-ACE or WINPCACE

The following steps are required:

Step 1.   Go the EmpireMedicare.com website and download the WINPCACE upgrade Version 1.55

2.     Step 2.  Modify the WINPCACE defaults as follows:           

Make the following changes to the Submitter Information screens in PC-ACE Pro32.

From the Main Menu

• Select Reference File Maintenance

• Select Codes/Misc tab

• Left-click the Submitter button

• Left-click View/Update with the Submitter you want to change highlighted .

Under the General tab

• If EIN is your Tax Id. with a leading zero, remove the zero

Under the Prepare tab

• EMC Output Format must equal A (ANSI)

• Submission Status – T = Test, P = Production (set to T now, and to P after the test passes.)

• ANSI Version (837) - must equal A1

• ANSI Version (276) leave blank

Under the ANSI Info tab

• Submitter Intchg ID Qual. must equal ZZ

• Receiver Intchg ID Qual. must equal 28

• Left-click Save to save your changes

3.           Step 3: Set Up of UPIN Codes on WINPCACE

There are a few edit changes you will notice under the new HIPAA requirements. One change is that with the HIPAA changes, WINPCACE requires a physician's Employer Identification Number or Social Security Number (EIN/SSN) to be included in every claim. The best way to address this issue is to do the following:

Print out a listing of all Physicians in CHARTS - Print table file, 1, 11.

In WINPCACE:

Select Reference File Maintenance

Select Codes/Misc tab

Left-click the UPIN button

Left-click New (this should be done for every physician in the Charts table)

Add the UPIN Code, Last Name, First Name, Initial, Federal Tax ID and Type.

You can enter each physician's Employer Identification Number or Social Security Number (EIN/SSN) in the UPIN record. If entering the EIN, set the type to ‘E’, if the SSN number is entered set the type to ‘S’. When you import claims using PrintLink, the current UPIN on the UB92 will match the Reference file record and automatically add their EIN/SSN to the claim.

Step 4:   Submit a test to IVANS using a few claims.

Step 5:    Review Your Test Results

The following reports will be available from Empire Medicare and can be viewed or downloaded:

Short Confirmation Report - available 1 minute after transmission

EMC Receipts Report - available 1 to 2  hours after transmission. Please review this report to make sure that the records have been accepted.

Validation and Medicare Return Reports - available 1 day after submission, if your test was submitted before 3:00 pm.                                                                                   

These reports should be reviewed for any errors. If errors are found please contact Empire Medicare to assist you with the WINPCACE set up. Please note that if there are no errors the EMC Receipts Report will be found, but there will be no Validation and Medicare Return Report.

Step 6:  Email Empire Medicare If the test is successful send an e-mail to Robert.Snyder@EmpireBlue.com and inform him that you wish to be set up for 4010 A1 production. The e-mail should include the facility name and medicare provider number.

Step 7: After passing the test set the production indicator:

Go back to Step 2 and set the Submission Status to Production (P).

Page 5:  $1,590 Part B Limit for PT and OT   

Overview

Note: Do not implement the steps outlined in this section (pages 5 - 17) until it is clear that the therapy limits will be implemented and all therapy charges with service dates prior to September 1, 2003 have been posted.

Abstract. Effective September 1, 2003 the limits that were in effect during 1999 have been reinstated. These are limits that effect the amounts that can be billed to Medicare Part ‘B’ (for non-Medicare Part A residents). These limits are $1,590 per calendar year for Physical Therapy (PT) & Speech Therapy (SP) combined, and $1,590 per calendar year for Occupational Therapy (OT). The following programs have been modified to reflect these changes. Please note that a $1,590 limit translates to $1,272 of billings ($1,590 less 20% co-insurance).

The software assumes that Part B charges are only written off after the limits are exceeded. If you are currently writing off all Part B charges, your tables must be changed not to write off those charges until the limits are exceeded. After the billing has been sent to Medicare, a program can be run to write off the Part B charges that were posted [Write Off Part B Ancillaries ‘WOPARTB’ - System, 14, 8].

UB92INFO Update - UB92 Billing Information - [GM, 8, 2, 7]

This program has been updated to display the PT, OT limits. These limits are automatically tracked by the system and can be viewed on the following screen:  

Please note: The totals for the amounts previously billed for PT, OT and Speech as accumulated in the UB92INFO program were reset to zero upon loading this release. These totals will not be affected by any posting of charges with service dates before September 1, 2003.

POSTANCL - Post Ancillary Charges - [GM, 8, 2, ,2]

This program can be used, as in the past, to post ancillary charges. When posting PT, OT, or ST charges the system tracks the cumulative amount charged (see above). If the HCFA limits are exceeded, the amount over the HCFA limit is automatically written off.

Example (see screen above):

• Amount previously billed for PT is $1,490

• If the current therapy charge is $150, only $80 will be billed:

• ($1,590 limit minus $1,490 already billed, less 20% co-insurance)  

Page 7:  Resident Report Generator, PMGEN - new fields for PT and OT Amounts Used

The Part B PT and OT amounts that were already billed for each resident can be viewed with the Resident Master report generator  using the following fields:

• X14 - PT amount used

• X15 - OT amount used

This information can also be seen in the UB92INFO program described on the previous page.  

Note: There is no set-up required to implement the $1,590 limits.

Page 8: Verify that your Part B charges are NOT written off.

For Part B billing only.

Creating an Ancillary Billing Type Table File record:

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             N                 Y     Medicare   S___     NB__           N             Y                 N     Private    S___     PB__           N             N                 N     VA         S___     PB__           N             N                 N     Other      S___     PB__           N             N                 N       Bedhold    S___     NB__           N             Y                 N                                                     *PB = Part B                                                  **C  = Co Insurance Provider       Enter (F) To File (I) To Ignore:  F

Verify that your Part B charges are NOT written off (cont.).

Modify your ancillary table file:

ANCILLARY TABLE CODE MAINTENANCE       Main Key: 420    Secondary Key: PT_______  Description: PT VISIT____________     Classification: 00         RVU: .00__      Bill form (1/2): 1  Min _> Trt: ___   Anc. Bill Type: PB         Condition: __   HCPCS Code     : _______   Svc. Type Ind.: __                                Modifier: ______    Ancil. Basis:  T      GL Account No.: .0000____    T _ Treatment         Billing Revenue Code: 420      Ancillary Type:  N    D_Day V_Visit         Co_Ins.Ancillary#:  999       (I)_Included in Rate        Current           Diagnosis code   : ______     (N)_not in rate  (P)_Pvt    Charge *Supplier      Bill Bedhold(Y/N): _          Doctor: ___    25.00___   ___        Equip Cost (or Non Covered Daily Rate) Current: _______           _  Prior  _                                           Prior  : _______     rate    dates    Supplier   Service Type     UB92       Writeoff Percent    ______  ________    ___      Part A : __    Part A : Y   Immediate: .00   7    ______  ________    ___      Hicfa  : __    Part B : Y   Co_Insur.: 20.00 7    For Demo Project (Pseudo Charge) _ Based on Visits/Costed Requisition(V/C): V                (e.g., For PT,OT,ST use 'V', For Pharmacy,Supplies use 'C')    Enter (F) to File (I) to Ignore:   F

  4.   

4.	At Main Key type the first ancillary to be changed (or press PF 2) and press ENTER.
5.	At Anc. Bill Type type PB
6.	At Write-off Immediate type 0
	At Co-insurance type 20.00
7.	Press ENTER.
8.	Repeat from step 4 for each revenue type ancillary.

Page 10:  Entering the HCPCS Rates for 2003.

The rates for all PT, OT and Speech HCPCS codes must be accurate for 2003 for the limits to work properly.

Modify your ancillary table file:    

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. C 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

Set option 51 above as follows:  

Note: If you set this option to C or A you will cause a corresponding co-insurance record to be created for every ancillary that passes through the POSTANCL program.

Note: If you were already set-up for billing co-insurance or you have set the ‘PPS Ancil PR W/O’ option to ‘blank’  you may skip the balance of the co-insurance set-up instructions.    

Creating an Ancillary Billing Type Table File record:

Set-up required for billing Co-insurance (cont.).

Creating a Co-insurance Ancillary Table File Record.  

 

ANCILLARY TABLE CODE MAINTENANCE Main Key: 999▬▬ Secondary Key: CO-INSUR▬ Description: CO-INSUR▬▬▬▬▬▬▬▬▬▬▬▬ Classification: 00 RVU: .00▬▬ Bill form (1/2): 1 Min -> Trt: ▬▬▬ Anc. Bill Type: CI▬▬▬▬▬▬▬ Condition: ▬▬ HCPCS Code: ▬▬▬▬▬▬▬ Modifier: ▬▬ Svc. Type Ind.: ▬▬ Medicare Part B HFCA $: .00▬▬▬▬ Ancil. Basis: V GL Account No.: .0000▬▬▬▬ T - Treatment Billing Revenue Code: ▬▬▬ Ancillary Type: N D-Day V-Visit Co-Ins.Ancillary#: ▬▬▬▬▬ (I)-Included in Rate Current Diagnosis code : ▬▬▬▬▬▬ (N)-not in rate (P)-Pvt Charge *Supplier Bill Bedhold(Y/N): ▬ Doctor: ▬▬▬ 30.00▬▬▬ ▬▬▬ Equip Cost (or Non Covered Daily Rate) Current: ▬▬▬▬▬▬▬ - Prior - Prior : ▬▬▬▬▬▬▬ rate dates Supplier Service Type UB92 Writeoff Percent ▬▬▬▬▬▬ ▬▬▬▬▬▬▬▬ ▬▬▬ Part A : ▬▬ Part A : N Immediate: .00▬▬ ▬▬▬▬▬▬ ▬▬▬▬▬▬▬▬ ▬▬▬ Hicfa : ▬▬ Part B : N Co-Insur.: .00▬▬ For Demo Project (Pseudo Charge) - Based on Visits/Costed Requisition(V/C): ▬ (e.g., For PT,OT,ST use 'V', For Pharmacy,Supplies use 'C') Enter (F) to File (I) to Ignore: F

Set-up required for billing Co-insurance (cont.).

Changing your Revenue Code Ancillary Records.

Change (012-ANC)
                         ANCILLARY TABLE CODE MAINTENANCE

  Main Key: 420▬▬  Secondary Key: PT ▬▬▬▬▬   Description: PT VISIT▬▬▬▬▬▬▬▬▬▬▬▬

  Classification: 00         RVU: .00▬▬      Bill form (1/2): 1  Min -> Trt: ▬▬▬
  Anc. Bill Type: PB▬▬▬▬▬▬▬  Condition: ▬▬   HCPCS Code: ▬▬▬▬▬▬▬ Modifier: ▬▬
  Svc. Type Ind.: ▬▬                         Medicare Part B HFCA $: .00▬▬▬▬
   Ancil. Basis:  V      GL Account No.: .0000▬▬▬▬
   T - Treatment         Billing Revenue Code: 420      Ancillary Type:  N
   D-Day V-Visit    ---> Co-Ins.Ancillary#:  999▬▬     (I)-Included in Rate
       Current           Diagnosis code   : ▬▬▬▬▬▬     (N)-not in rate  (P)-Pvt
   Charge *Supplier      Bill Bedhold(Y/N): ▬          Doctor: ▬▬▬
   30.00▬▬▬   ▬▬▬        Equip Cost (or Non Covered Daily Rate) Current: ▬▬▬▬▬▬▬
          -  Prior  -                                           Prior  : ▬▬▬▬▬▬▬
    rate    dates    Supplier   Service Type     UB92       Writeoff Percent
   ▬▬▬▬▬▬  ▬▬▬▬▬▬▬▬    ▬▬▬      Part A : ▬▬    Part A : Y   Immediate: .00▬▬ 7
   ▬▬▬▬▬▬  ▬▬▬▬▬▬▬▬    ▬▬▬      Hicfa  : ▬▬    Part B : Y   Co-Insur.: 20.00 7
   For Demo Project (Pseudo Charge) - Based on Visits/Costed Requisition(V/C): ▬
               (e.g., For PT,OT,ST use 'V', For Pharmacy,Supplies use 'C')
   Enter (F) to File (I) to Ignore:   F

Page 15: Using POSTANCL to enter Part B ancillary charges and co-insurance records.

Abstract. Residents who are not Medicare Part A, and who have Medicare Part B coverage can be billed for therapy services. The POSTANCL program now also allows for co-insurance charges to be created. This works as follows:

Example:

Assume you had previously billed $1,490 of PT services for a resident. You then entered a PT charge of $150 (either through POSTANCL and you did not post it yet, or through CRANCIL).  

(Note: When entering ancillary charges you can suppress the creation of co-insurance records by placing an N at Auto Bill Co-Insurance.)  

3.  At 

2.	Leave S-Save/B-Begin as initialized to S and press ENTER:
3.	Patient type 0 to end and press ENTER.
4.	At L-List, P-Post type P
5.	At Print Option type S
6.	Press ENTER

The following report appears:  

1.                    Prior to this transaction the facility had already billed $1,490 PT for this resident.

2.                            Based on a current therapy charge of $150, $80 will be billed to Part B.

            (($1,590 limit minus $1,490 already billed, less 20% co-insurance)  

Running this patch will automatically update your Federal, New York State and New York City tax tables. Check that these tables are updated correctly as follows:

Check your Federal Tax Table by typing FEDTAX or [PR, 8, 2, 1] and pressing ENTER.

(IRS CIR E ANNUAL)          FEDERAL TAX INFORMATION
                        Single                       Married
                     Rate       Cutoff            Rate       Cutoff
  level  - 1      10.00     2650.00▬▬            10.00     8000.00▬▬
         - 2      15.00     9700.00▬▬            15.00     22300.00▬
         - 3      25.00     30800.00▬            25.00     64750.00▬
         - 4      28.00     68500.00▬            28.00     118050.00
         - 5      33.00     148700.00            33.00     185550.00
         - 6      35.00     321200.00            35.00     326100.00
         - 7      .00▬▬     .00▬▬▬▬▬▬            .00▬▬     .00▬▬▬▬▬▬
 Annual Exemption           3100.00▬▬                      3100.00▬▬
                               -- Earned Income Credit --
  Level  - 1      7370      20.40▬▬▬▬            3685▬     20.40▬▬▬▬
         - 2      13520     1503▬▬▬▬▬            7260▬     752.00▬▬▬▬▬▬
         - 3      .00▬▬     .00▬▬▬▬▬▬            .00▬▬     .00▬▬▬▬▬▬
 Min/Max Rates    .00 ▬     9.59▬                .00▬▬     9.59▬

  FICA  Employer  7.65▬     87000.00▬  Employee  7.65▬     87000.00▬
        level 2   1.45▬     999999.00  level 2   1.45▬     999999.00
                                         Unempl  .00▬▬     .00▬▬▬▬▬▬

STATE TAX INFORMATION

  ----------  S I N G L E ----------        --------- M A R R I E D -------
   [level 01-06]     [level 07-12]           [level 01-06]     [level 07-12]
  Rate    Cutoff     Rate    Cutoff         Rate    Cutoff    Rate    Cutoff
  4.00▬   .00▬▬▬▬▬▬  9.44▬  100000.00       4.00▬  .00▬▬▬▬▬▬  8.14▬  100000.00
  4.50▬   8000.00▬▬  11.25  150000.00       4.50▬  8000.00▬▬  12.55  150000.00
  5.25▬   11000.00▬  8.65▬  200000.00       5.25▬  11000.00▬  8.65▬  200000.00
  5.90▬   13000.00▬  9.05▬  500000.00       5.90▬  13000.00▬  9.05▬  500000.00
  6.85▬   20000.00▬  .00▬▬  .00▬▬▬▬▬▬       6.85▬  20000.00▬  .00▬▬  .00▬▬▬▬▬▬
  7.64▬   90000.00▬  .00▬▬  .00▬▬▬▬▬▬       7.64▬  90000.00▬  .00▬▬  .00▬▬▬▬▬▬

  SDI  Employee    : .50▬▬  31.20▬▬▬▬                        Annual Exemptions
  SDI  Employer    : .50▬▬  31.20▬▬▬▬                         Amount 1000.00▬▬
  SUI  Employer    : ▬▬     8500.▬▬▬▬                         Rate   .00▬▬▬
  SUI EMPLOYER RATE IS SPECIFIC TO YOUR FACILITY. <---
  LEAVE AS IS ON YOUR SYSTEM OR RETRIEVE FROM 2002 PAYROLL. <---
                  Annual  Deduction                         2nd State Tax
               Single       6975.00▬▬                  Annual Exempt .00▬▬▬▬▬▬
               Married      7475.00▬▬                  Fica Ded. to  .00▬▬▬▬▬▬
               Head House   7475.00▬▬
 Last changed by:REL ON 062003 10.21am # of changes:  1 Chg.#1-Head Hs Deduct

CITY TAX INFORMATION

                    Rate     Cutoff                        Rate     Cutoff
  level  - 1       1.90▬   .00▬▬▬▬▬▬       level  - 8     8.08▬   150000.00
         - 2       2.65▬   8000.00▬▬              - 9     5.20▬   200000.00
         - 3       3.10▬   8700.00▬▬              - 10    5.60▬   500000.00
         - 4       3.70▬   15000.00▬              - 11    .00▬▬   .00▬▬▬▬▬▬
         - 5       3.90▬   25000.00▬              - 12    .00▬▬   .00▬▬▬▬▬▬
         - 6       4.00▬   60000.00▬              - 13    .00▬▬   .00▬▬▬▬▬▬
         - 7       5.20▬   100000.00              - 14    .00▬▬   .00▬▬▬▬▬▬

                    Rate     Cutoff                     Single      Married
 Surcharge         .00▬▬   .00▬▬▬▬▬▬       Deduction  5000.00▬▬   5500.00▬▬
                   .00▬▬   .00▬▬▬▬▬▬


 Annual Exemption  Amount  1000.00▬▬
 Annual Deduction  Rate    .00▬▬

*** END OF DOCUMENTATION ***