Please note that Step 1 of this letter (loading the enclosed diskettes) is applicable to all clients. Steps 2 through 7 are applicable only to those clients who are participating in the Medicare Demonstration project.
Updated versions of the Census and Accounts Receivable programs are required before posting Medicare charges for 1996. For Wang and Unix clients, these updates are enclosed. If you have a DOS or Novell system please call us when you receive these diskettes and our client service department will assist you in loading them onto your system.
Please note: If your facility is part of the Medicare demonstration project, we assume, that you or
someone in your facility attended one of the DOH Medicare seminars. If you did not attend the DOH
Medicare seminar please ask someone in your facility to explain to you the Medicare
Demonstration concepts and guidelines before attempting to follow the instructions in this letter.
OVERVIEW - Details on the following page:
The following general steps are required before posting Medicare
charges for 1996:
Set-up: To be performed only once:
1. Load the enclosed diskettes.
2. Verify that the Sub Type Table has been loaded.
3. Confirm that your facility is using the table file to store your
rates (as opposed to the NHHRF user parameter file).
4. Confirm that your NHHRF file (NHMA) indicates that you are part
of the RUGs III demonstration project.
5, Enter the Medicare daily rates for each of the 45 RUGs III
categories.
Processing: Required each month prior to Medicare billing:
6. For each Medicare resident enter one or more Change of Status
record to reflect the correct RUGs III grouping.
7. Post the Medicare Room & Board charges and create the UB92 billing
diskette.
INSTRUCTIONS:
The following steps must be followed before posting Medicare charges for 1996:
Step 1. Load Charts Update:
Follow the instructions on the diskettes to
load them into your CHARTS system. (DOS and Novell clients should
skip this step.)
Step 2. Confirm that the Sub Types Option Table has Been Loaded:
From any CHARTS menu type 'CTF' (change a Table File), select '8' (Accnts.
Receivable), select '19' (Sub Types Options), then press PF'2.
A listing of sub types starting with 9000 should appear. If it
appears, exit from the program. If it does not appear please call
client services and this table will be electronically downloaded.
This new table links the 45 rates with a specific accounts
receivable sub type. For example, the Rugs III classification
RVC would be linked to a billing rate code 51 and the Rugs III
classification RVB would be linked to a billing code 52.
Step 3 Confirm that your Billing Rates are Table File Driven:
From any CHARTS menu type 'NHMA'. Make sure that the 'Rates and
Dates From TF' option on the top left of the screen is set to 'Y'.
If this option is not set to 'Y' please call client services
for further instructions.
Step 4. Confirm that your NHHRF file (NHMA) indicates that you are part
of the RUGs III demonstration project:
When you run the NHMA program mentioned in step 3 above make sure
that you have a Y at the RugsIII Demo option.
Step 5. Update the Rates and Dates Table:
Medicare billing will be based on the 45 RUGs III classifications.
The Rates and Dates table file must be updated to reflect these 45
rates. This table is accessed by typing TF, 1, 8, 12.
Codes 51 - 95 must be used corresponding with the 45 Rugs III
codes. Enter all 45 Medicare rates for your facility (with rate
95 being the Default rate). A complete listing of the Rugs III
Classifications and their corresponding RHS Rates and Dates
codes is enclosed. (See the last page, Rugs III Group - RHS Rate
Codes Crosswalk.) Please note that Medicare billing rates still
vary from facility to facility. It is therefore necessary that
each facility enter their own billing rates for each RUGs III
group.
For example, for Rehabilitation Very High ADL 14-18 (RVC) with
a facility specific rate for that grouping of $180.00 per day,
enter the following: