1/3/96 Updates to Medicare Demonstration Project:
January 3, 1996
Dear Client,
The purpose of this memo is to inform our clients about several programming
updates and procedural changes related to the Medicare Demonstration Project
beginning January 1996.
MDS+ Submissions
1) Facilities participating in the Demonstration project must submit full MDS+
assessments for all residents with an assessment date of January 1, 1996 or
later. Partial quarterly assessments will no longer be accepted. This rule
applies to ALL residents, not just Medicare covered residents as specified in a
letter from DOH dated December 15, 1995. Therefore, for clients in the
demonstration project, the MDS+ Core entry programs should NOT be used for
assessments with an assessment date of January 1, or later.
2) The entry and submission of MDS+ assessments with an assessment date before
January 1, 1996 should continue as in the past, with the core entry program used
for those assessments.
3) For clients participating in the Medicare Demonstration Project, before
submitting MDS+ assessments with an assessment date of January 1 or later the
following is required:
a) The 'Record Completion Mode' must be changed from 'P'(partial) to
'F'(full) in the DOH MDS+ Submission software. Please see the
instructions from DOH titled 'Instructions to Change Record
Completion Mode From Partial to Full' mailed December 15, 1995 by
the DOH. (Also please note, that if after submitting 1996 MDS+
batches, a facility wants to submit a 1995 batch, the indicator
would have to be changed back from 'Full' to 'Partial'.)
b) An update of the RHS MDS+ Disk Submission program (MDSDISK) is
required. For Wang and Unix clients, this update is enclosed. For
DOS and Novell systems the update will be transfered by modem before
January 11, 1996.
Although MDS+ assessments can currently be entered, DO NOT submit
1996 batches before receiving and loading this program.
c) After loading the diskette, from any CHARTS menu type 'NHMA' and
in response to the question on the top right of the screen 'RugsIII
Demo:' respond 'Y'.
Please review the DOH December 15, 1996 letter for additional details.
MEDICARE BILLING SUB-CLASSIFICATIONS
1) Starting this month Medicare residents will be billed based on RUGS III
classifications. We have modified our software to allow for a billing Sub Type
in addition to our regular billing classifications. For example a resident can
be classified as Medicare (Bill type #21) with a sub type of RVC (Sub type
#9044). A Sub Type Table File will be released with this update which will
contain the RUGS III index and additional information associated with each
Medicare sub type [TF, 2, 8, 19 - Sub Type Option]. This update along with the
appropriate tables is scheduled to ship January 29, 1996. Upon receiving this
update one or more change in status records [GM, 1, 4] will have to be entered
for all medicare residents to correctly reflect the Medicare Sub Type.
2) A revised version of the Post Room and Board Charges program [GM, 8, 2, 1] and
a revised version of the UB92 Billing program [GM, 8, 3, 3, 1] that takes into
account the new 9000 series of revenue codes is scheduled to ship January 29,
1996. Medicare charges should not be posted before receiving and loading this
update. Note, that with the revised billing programs, the differences between the
standard Medicare rate and the actual rate based on Rugs III class will be
treated as a contractual.
I would also like to clarify an additional point. Those facilities participating
in the demonstration project must submit UB92 claims electronically. I have
discussed this with MetraHealth and have been informed that both diskette and
modem billing submission fulfill this requirement.
We are also updating out client database to indicate which of our clients are
participating in the Medicare Demonstration project. Please call Camille at 718-338-2400 to inform us if your facility is participating. This will
allow us to provide software updates in a more timely fashion.
For additional assistance or for more information feel free to call either our
client services department or the New York State Department of Health (1-518-474-2881).
Sincerely,
Bud Westreich
Vice President Systems Development
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