October 2006. This patch contains the latest updates for: 1) Billing Medicare using the Facility NPI (national provider identifier), 2) Implementation of the new Medicare standard for billing Benefits Exhausted and No-Payment claims, and 3) Medicare Rates for New York City and Nassau/Suffolk Counties (effective October 2006).
Medicare Billing using the Facility NPI
The Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandated the adoption of standard unique identifiers for health care providers. Starting October 2, 2006 CMS systems will begin to accept the NPI on claims. During an interim period from October 2, 2006 until May 22, 2007 if an NPI is not provided on a billing claim the legacy Medicare billing number will continue to be accepted. The same applies to the physician NPI. During the interim period if the physician NPI is not available the physician UPIN or other license numbers will continue to be used.
The facility should take the following steps during this interim period:
1) Make sure that your facility has applied and has been issued a 10 digit NPI.
2) Make sure that your physicians have applied and have been issued NPI numbers.
If an NPI number is available the Medicare claim will be sent using the corresponding Facility NPI and/or Physician NPI numbers.
Future updates will be available for Medicaid, HMO, Physician Billing and Pharmacy billing that incorporate the NPI.
The facility NPI number can be entered in User Parameters Screen #1 - Basic Information [UP, 1].
The physician NPI can be entered in the Physician ID's table file - [CTF, 1, 16].
Please Note:
To successfully submit claims with the new NPI number you need to inform Empire Medicare, prior to submission, that your claims contain the NPI number. Please see http://www.empiremedicare.com/news/partanews06/092706imp.htm for additional details.
After this update has been loaded the facility MUST review all reports retuned by Medicare to verify that claims are continuing to be accepted.
Implementation of the new Medicare standard for billing Benefits Exhausted and No-Payment claims
Background:
An SNF is required to submit a bill even when no benefits are payable by Medicare. CMS maintains a records of all inpatient services for each beneficiary, whether those services are covered by Medicare or not. This information is used for national healthcare planning and it also enables CMS to keep track of a beneficiary's benefit period. These bills are required in two situations:
When the beneficiary has exhausted their 100 covered days (referred to as 'Benefits Exhausted Bills')
When the beneficiary no longer need a Medicare covered level of care (referred to as 'No-Payment Bills')
In summary, for residents covered by Medicare on or after October 1, 2006:
Simulated Covered claims must be submitted monthly through discharge for residents who have exhausted their benefits.
No-Pay claims are only submitted upon discharge for residents who were once Medicare covered but now require non-skilled care.
For additional information please review the following publication from CMS www.cms.hhs.gov/MLNMattersArticles/downloads/MM4292.pdf
CHARTS Implementation of Benefits Exhausted and No-Payment Bills:
A new screen has been designed that maintains the required key Medicare dates. This screen is presented below:
Medicare Gap Billing Information [CC, 14, 12]
MEDICARE GAP BILL INFORMATION Resident: Sample,Resident▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬ 10001 Create a Gap Bill Indicator : Y Medicare Benefits Exhausted On: 10/15/2006 Transfer to Non-Skilled Care : ▬▬▬▬▬▬▬▬▬▬ Medicare Discharge Date : ▬▬▬▬▬▬▬▬▬▬ |
The dates that are on the screen are automatically updated by the UB92 billing program. When a Medicare bill is printed with a Code of 'A3' (benefits exhausted ) on the bill, the UB92 program updates the 'Medicare Benefits Exhausted' date on the Medicare Gap Bill Information screen. Similarly, when a code '22' (transfer to a non-skilled level or care) is printed on a UB92 bill, the 'Transfer to Non-Skilled Care' date is updated. The only situation when the client must manually update a date is when after a Benefits Exhausted situation the resident transfers to a non-skilled level of care.
Each month after submitting the regular Medicare bills, the facility should run a new program to process Benefits Exhausted and No-Payment Bills. This program will produce a monthly bill for every resident in the facility that was once covered by Medicare as long as they remain at a skilled level of care. It will also produce a no-pay bill for any resident who has been discharged during the current month, who was once covered by Medicare and who is now receiving non-skilled care.
UB92 Gap Bills [AR, 3, 3, 4]
UB92 - NON COVERED GAP BILLS (October '06) From Patient: A▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬ To Patient: ZZ▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬ Date Range : 10-01-2006 - 10-31-2006 Default UPIN: A00001 Signature : ▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬ Print Option: S Print on UB92 laser forms: Y Diskette or Paper UB92 (D/P): D Override Type of Bill: ▬▬▬
Override MDS Date : ▬▬▬▬▬▬▬▬▬▬
Override HIPPS Code : ▬▬▬▬▬
*** For Diskette Billing Only *** Billing -> New billing: Y
File: PB▬▬▬▬▬▬ Library: TAPELIB▬ Volume: VOL288
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After this program is run, the next step is to run the HIPAA Medicare Billing 837 program [AR, 3, 3, 8]. The HIPAA Medicare Billing program will produce a HIPAA formatted file that can be submitted to Medicare for processing.
Note: We do not recommend combining both a) regular Medicare bills for payment, with b) Benefits Exhausted / No-Payment type bills on the same transmission. Additionally, the facility MUST review all reports retuned by Medicare to verify that all claims are being accepted.
Updated Medicare Rates for New York City and Nassau /Suffolk Counties
Note: The rates should only be updated after the September 2006 Medicare billing has been posted.
This update includes the October 2006 rate revisions for Medicare.
To update your rates type ‘RHSTF’ from any Charts menu.
The ‘R.H.S. Table File’ should be initialized to ‘TFRATE06’. Press Enter.
Load RHS table file to client
R.H.S. Table File: TFRATE06 Library: CHARTS Volume: VOLB
Client Table File: TFFILE Library: ________ Volume: VOLB
Delete the Specific Table before copying : N (Yes, No, Default)
When using default, if RHS file="NEWTF" it won't delete.
if RHS file="NEWTF2" it will delete.
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The updated rates can be viewed in Print Table File ‘PTF’ – AR, 25 Medicare Rates or modified in Change Table File ‘CTF’ – AR, 25 Medicare Rates.
If you have any additional questions please feel free to call client service at (718) 338-2400.
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