The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 has increased by 128% the per diam RUG payment for SNF residents with Acquired Immune Deficiency Syndrome (AIDS). This increase will apply to services furnished on or after October 1, 2004.

Patch 012 is scheduled for formal release in mid October. You will be notified by e-mail when to load the patch. The October 2004 Medicare rates for New York State facilities are included in this release. In any case the new Medicare rates should not be entered until after the October Update is loaded.

Section 511 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) increases by 128% the per diem Resource Utilization Group (RUG) payment for an SNF resident with Acquired Immune Deficiency Syndrome (AIDS). This increase will apply to services furnished on or after October 1, 2004. Claims with primary diagnosis code ‘042' will receive the additional payment.

The CHARTS October ‘04 update contains a modified version of the Post Room and Board Charges program that based on a primary Aids diagnosis of ‘042' will bill Medicare at the Aids adjusted rate. The CHARTS October ‘04 update also contains both the standard Medicare PPS prices and the Medicare PPS Adjusted prices for residents eligible for the Aids adjusted prices. For facilities using the following Medicare rates there will be no need to enter the new October ‘04 prices: NYC, Nassau County, Syracuse, and rural rates.

c. What the Facility Must Do (after loading the CHARTS ‘October ‘04 Update)

1. Review the CHARTS Patient Master Medical Diagnosis for any patients with AIDS to make sure that the primary diagnosis is ‘042'. The special adjusted rate will only be processed based on the Primary Diagnosis (Patient Master Medical Diagnosis #1).

2. From any menu type ‘UP’, press enter. Type ‘8' for Table File Offset Information.

For Nassau County rates: Enter ‘203' as the table name and ‘NC’ as the code in any available slot.

For Syracuse: Enter ‘203' as the table name and ‘SY’ as the code in any available slot.

For Rural rates: Enter ‘203'as the table name and ‘RU’ as the code in any available slot.

For NYC rates: Skip this step.

For any other locations: Enter ‘203' as the table name and ‘OT’ as the code in any available slot and then proceed by typing ‘CTF’ , 8, 25 and then enter the appropriate rates for items ‘51' thru ‘95' (Medicare rates) and ‘151' thru ‘195' (adjusted Aids rates). For example to enter in the regular Medicare RUC code, enter the Code: ‘051' and the Year: ‘2004'.

3. Verify the rates by printing the Medicare rates table [PTF, 8, 25].

4. When listing Medicare Room and Board Charges [AR, 2, 1] - please review the printout to verify that the rates are correct for all residents, especially for that with a primary diagnosis code of ‘042'. Note, a ‘$’ will appear on the far right next to the Rugs group for any resident being paid at the adjusted Aids rate.

Note: That the Medicare October 2004 rates are now contained in a new Medicare Rates Table [CTF, 8, 25] . This applies to both the standard Medicare rates [51 - 95] and the Adjusted Medicare Aids rates [151 - 195]. The rates prior to October 2004 are still contained in the Rates and Dates table [CTF, 8, 12].

The October ‘04 release will remove the non HIPAA compatible Medicaid billing programs from the menu. Since Medicaid will not pay any claims submitted in a non HIPAA compatible format after October 6^th, 2004 these programs are no longer needed.

This release contains software that will allow for HIPAA compliant billing to Blue Cross and Proxymed (a HMO clearinghouse). For additional information on setting up Proxymed see:

P3362 [UB92 ] Set-up for billing PROXYMED (Evercare) electronically.

For additional information on setting up Blue Cross see:

P3363 [UB92 ] Set-up for billing BLUE CROSS electronically. 

New Diagnosis Codes as of October 1, 2004

As of October 1, 2004 there are new diagnosis codes. A list of these new codes can be found on the CMS web site www.cms.hhs.gov/medlearn. The PDF file is at http://www.cms.hhs.gov/medlearn/table6a04.pdf.

Updating your Diagnosis Table File:

Add the relevant diagnosis codes to your Diagnosis Table File using [ATF, 1, 3].

Invalid diagnosis codes may be flagged as invalid as/of 10/1/04 using [CTF, 1, 3].

For example to mark diagnosis codes V46.1 as invalid, type [CTF, 1, 3] and complete as follows:

Change (003-D )

Diagnosis Table

Main Key: V46.1    Secondary Key: DEPEND R Description: DEPENDENCE ON RESP


Long Description: DEPENDENCE ON RESPIRATOR

Currently valid (Y/N): N <---
(If Invalid ... Effective until: 10/01/2004 ) <---

Updating your Resident Master File:

Diagnosis codes in you resident files may be changed either manually or automatically as follows:

Manually: For each resident affected type UB92INFO and change their diagnosis code.

Automatically: Type, [SY, 1, 15, 15, 12]. For each diagnosis to change, type: the invalid code, the valid code and the effective date (10/1/04).

END