Provider Outreach and Education November 16, 2010

This resource is not a legal document. This presentation was prepared as a tool to assist our providers. This presentation was current at the time it was created. Although every reasonable effort has been made to assure accurate information, responsibility for correct claims submission lies with the provider of services. Reproduction of this material for profit is prohibited.

 Memorandum released August 9, 2010 ◦ Window.asp Window.asp  Outpatient non-diagnostic services  Clinically associated with the reason for a patient’s inpatient admission  Bundle on the inpatient claim and include all diagnoses, procedures and charges  Effective June 25, 2010

 Released October 29, 2010 ◦  Non-diagnostic services unrelated to the inpatient claim ◦ Clinically distinct or independent from the reason for admission  Separately billable to Part B  Maintain documentation in medical records  Beginning April 1, 2011, utilize condition code 51

 Change Request 6960  Change Request 7080 elaborates upon these guidelines ◦ For institutional claims that include span dates of service, the “Through” date on the claim shall be used to determine the date of service for claims filing timeliness Date of ServiceTimely Filing Guidelines January 1, 2010 and afterWithin one year after date of service October 1, December 31, 2009 December 31, 2010 October 1, September 30, 2009 December 31, 2010

 The 2010 results are now available!  Cahaba GBA Part A overall satisfaction score: ◦ 3.77  For questions or concerns: ◦ Contact SciMetrika, LLC  

 New HIPAA mandated electronic format  Current format is ANSI version 4010A1  Version 5010 is essential for the use of ICD-10-CM  Compliance date is January 1, 2012  0.asp

 Provider Action Checklist for a Smooth Transition  Checklist for Level I Testing  New Health Care Electronic Transactions Standards: Versions 5010, D.0., and 3.0 Fact Sheet  Preparing for Electronic Data Interchange Standards: The Transition to Versions 5010 and D.0. Fact Sheet CMS has created new educational materials that inform providers of the changes associated with HIPAA 5010 and how they need to plan for their implementation

ICD-9-CM has:  3, 4 or 5 digits  Chapters 1 – 17 (all numeric)  Supplemental chapter  1 st digit is alpha (E or V)  all others are numeric ICD-10-CM has:  3-7 digits  Digit 1 is alpha* (A-Z)  Digit 2 is numeric  Digit 3 is alpha* or numeric  Digit 4-7 are alpha* or numeric *Alpha is not case- sensitive

DateCompliance Step January 1, 2010Payers and providers should begin internal testing of Version 5010 standards for electronic claims December 1, 2010Internal testing of Version 5010 must be complete to achieve Level I Version 5010 compliance January 1, 2011 Payers and providers should begin external testing of Version 5010 for electronic claims CMS begins accepting Version 5010 claims Version 4010 claims continue to be accepted December 31, 2011External testing of Version 5010 for electronic claims must be complete to achieve Level II Version 5010 compliance January 1, 2012 All electronic claims must use Version 5010 Version 4010 claims are no longer accepted October 1, 2013 Claims for services provided on or after this date must use ICD-10 codes for medical diagnosis and inpatient procedures CPT codes will continue to be used for outpatient services

November 2009 CERT Error – 7.8% for all fee-for- service providers  CERT Errors Medical necessity Insufficient documentation Incorrect coding

 Connolly Consulting, Inc. handles the Cahaba GBA workload  Remark code N432 is used to identify RAC claims  Demand letter is issued by the RAC Medical records  45 days  Paper, CD or DVD issues.aspx

 Final rule announced on July 13, 2010  Initiated by the American Recovery and Reinvestment Act of 2009  Incentive payments will be available  Eligible hospitals can register starting January 2011 ◦ Subsection (d) hospitals paid under IPPS ◦ Critical Access hospitals ◦ Medicare Advantage hospitals

 Computer base training courses  New account tutorial  Assessment Tools  Recorded educational events  Free enrollment  Courses available 24/7 Connect, Enroll, Cahaba University

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