1. Presented by Blue Cross and Blue Shield of Kansas
2016 Ambulatory Surgery Center (ASC) Webinar
Presented by Blue Cross and Blue Shield of Kansas

2. Presenters Janne Denton, BSN RN
Contract & Specialty Provider Consultant
Connie Winkley
Education and Communications Coordinator
Misty Tillman
Provider Program Specialist

3. Today's Agenda BCBSKS Website/BlueAccess/Availity
Institutional Relations Department
Billing Overview
Quality-Based Reimbursement Program (BCBSKS)
Medical Policies
2017 Contract Changes
Questions and Answers

4. BCBSKS Website/BlueAccess/Availity
BCBSKS Public Website –
Includes information for providers which does not require secure access including:
Newsletters
Workshops and Training
Medical Policies
ASK/EDI
ICD-10
Pre-Service Review
FAQs
Glossary
Access to other blue plans pre-services review information.
eNews – Sign up so that you are not left behind!

5. BCBSKS Website/BlueAccess/Availity
Availity Web Portal - Secure Website
BCBSKS moved secure information to Availity in August 2013
The following BCBSKS Member information can be found on the Availity Web Portal:
Eligibility and Benefits
Claims Status
Requires secure log in
Access granted from the facility's Availity Access Administrator (AA)
Several payers use Availity, including other Blue Plans and CMS/Medicare
Recent changes to the Availity Web Portal includes the ability to add your favorite tools to you home page.

6. BCBSKS Website/BlueAccess/Availity
BlueAccess – BCBSKS Secure Website
Accessible only by logging onto the Availity Web Portal
The following information can be found on BlueAccess:
Remittance Advice
Institutional Provider Manual
Patient ID (BCBSKS Member) Search
Pre-Service Review
Institutional Providers General Policies and Procedures
Other secure documents

7. Institutional Provider Relations Department
Functions of the Institutional Provider Relations Dept:
Liaison between provider and BCBSKS
Manage facility contracts
Provide Training and Education
Communication
Inquiries

8. Institutional Provider Relations Department
Provider Types:
Ambulatory Surgery Centers (ASCs)
Birthing Centers
Dialysis Centers
Home Health Agencies
Hospice Facilities
Hospitals (Acute, Rehab, Psych, Military and VA)
Substance Abuse

9. Institutional Provider Relations Department
Institutional Provider Relations Department Staff
Director – Angie Strecker
Manager – Teresa Van Becelaere
Provider Consultants:
Cindy Garrison – Topeka – Northern KS Hospitals
Sally Stevens – Wichita – Southern KS Hospitals
Janne Denton – Topeka – Ancillary Provider
Education and Communication Coordinator – Connie Winkley
Claims Research Analyst – Katie Dennison
Provider Program Specialist – Misty Tillman

10. Institutional Provider Relations Department
Institutional Provider Relations Department Staff:
Support Staff:
Administrative Coordinator – Topeka – Dona Hewes
Administrative Assistant – Topeka - Melanie Moriarty
Administrative Assistant – Wichita – Kristi Donelan

11. Institutional Provider Relations Department
ICD-10 Systems and Hospital Audits
Administrator – Rhonda Knoerschild
Senior Field Representative – Todd Colglazier
ICD-10 Coding Specialist – Sheryl Wilson
Administrative Assistant – Mary Schneider

12. Billing Overview UB-04 Claim Form
UB-04 submission will apply facility claim edits to ASC's
See Institutional Provider Manual (IPM) for sample of UB-04 claim form and requirements for ASCs

13. Billing Overview UB-04 Claim Form Field Locator Completion Details
FL 14 – REQUIRED
PRIORITY (TYPE) OF ADMISSION OR VISIT
Enter the appropriate code indicating the priority of this admission/visit.
  FL 15 – REQUIRED (except for TOB 014x)
POINT OF ORIGIN (PoO) FOR ADMISSION/VISIT
Enter the appropriate code indicating the point of patient origin for this admission/visit. The PoO is where the patient came from before presenting to the health care facility. See Blue Cross newsletter BC for additional information.
FL 17 – REQUIRED
PATIENT DISCHARGE STATUS
Enter the appropriate two-digit code indicating the patient's discharge status. Note: This is required on all inpatient, observation, or emergency room care claims. For additional information see BCBSKS Newsletter BC

14. Billing Overview UB-04 Claim Form Field Locator Completion Details
FL 51 – NOT REQUIRED BY BCBSKS
HEALTH PLAN IDENTIFICATION NUMBER
Enter the number used by the health plan to identify itself.
FL 52 – NOT REQUIRED BY BCBSKS
RELEASE OF INFORMATION
Enter a "Y" or "I" to indicate if the provider has a signed statement on file from the patient or patient's legal representative allowing the provider to release information to the carrier. The member's BCBSKS agreement allows us to obtain this information from providers without the signed statement.
FL 53 – NOT REQUIRED BY BCBSKS
ASSIGNMENT OF BENEFITS
Enter a "Y", "N", or "W" to indicate if the provider has a signed statement on file from the patient or patient's legal representative assigning payment to the provider.

15. Billing Overview UB-04 Claim Form Field Locator Completion Details
FL 70 – REQUIRED FOR UNSCHEDULED OUTPATIENT VISIT
PATIENT'S REASON FOR VISIT
Enter the appropriate diagnosis code describing the patient's reason for the visit at the time of the outpatient encounter only for bill types 013X, 085X, 045X, 0516, 0526, or N/A for Ambulatory Surgery Centers
FL 71 – SITUATIONAL
PROSPECTIVE PAYMENT SYSTEM (PPS) CODE
Enter the PPS code assigned to the claim to identify the DRG based on the grouper software called for under contract with the primary payer. N/A for Ambulatory Surgery Centers

16. Billing Overview UB-04 Claim Form Field Locator Completion Details
FL 72 – SITUATIONAL
EXTERNAL CAUSE OF MORBIDITY AND PRESENT ON ADMISSION INDICATOR
Enter the cause of injury code or codes when injury, poisoning, or adverse affect is the cause for seeking medical care. N/A for Ambulatory Surgery Centers
FL 74 – REQUIRED FOR INPATIENT PROCEDURE
PRINCIPAL PROCEDURE CODE AND DATE
Enter the principal procedure code and date using a six-digit format (MMDDYY) if the patient has under gone an inpatient procedure. N/A for Ambulatory Surgery

17. Billing Overview UB-04 Claim Form
Charges for all ASC services, procedures, supplies, equipment and/or implants provided during an outpatient are billed on one claim using the ASC's NPI billing number.
Payment for outpatient surgeries will be reimbursed at an all inclusive rate, based on the MAP.

18. Billing Overview Maximum Allowable Payment (MAP)
MAPs are set at a surgical level payment
All procedures eligible for reimbursement in the ASC are MAP'd
Multiple surgeries are reimbursed based on the highest MAP'd surgical code
The total surgical MAP is allocated proportionally over all lines of the claim
MAP lists are mailed annually with contracts, but an electronic (excel) copy of the MAP list can be requested, as well.

19. Billing Overview Limited Patient Waiver (LPW)
Submit claims with GA modifies appended to the CPT/HCPCS code

20. Billing Overview Limited Patient Waiver (LPW)
The waiver is retained in the patient's file
By obtaining a signed LPW, the Not Medically Necessary (NMN) or Experimental/Investigational (E/I) charges are denied as the patient's responsibility
Cannot use a blanket waiver
If providers use their own waiver form, as opposed to the BCBSKS form, BCBSKS highly recommends that you have your IR Provider Consultant review the waiver to ensure it contains all required information

21. Welcome to Availity Type in www.availity.com into the browser window
Click on the Login to get started!

22. Log into Availity…
Recommendations: Add this page to you Favorites for quick and easy access

23. Availity continued…
Click on the Blue Cross and Blue Shield payer space.

24. BlueAccess
Click on the BCBSKS
Provider Secure Section (Blue Access)

25. Select your facility name from the drop down menu.
BlueAccess
Select your facility name from the drop down menu.

26. BlueAccess
Enter your institution's tax ID number.

27. BlueAccess
Make sure that you select the NPI with (Inst) next to it. DO NOT select the Professional organization!

28. Accessing the QBRP Portal!
Click on QBRP Portal

29. Quality Based Reimbursement Program

30. Quality Based Reimbursement Program
Click on QBRP Form to report your prerequisites, data, and attestations

31. Quality Based Reimbursement Program
Program Description
Explains what QBRP is.
Measure Set Descriptions
Detailed guide to each measure.
Recent Publications
Provides links to any publications that BCBSKS has made about QBRP .
Portal Instruction Manual
QBRP Portal User Guide

32. Program and Measure Set Description

33. Program and Measure Set Description

34. Quality Based Reimbursement Program
This feature is not available for ASC facilities.

35. Quality Based Reimbursement Program
My Scorecard
This function will be available in 2017.
Update Contact Information
This can be used for administrative and demographic changes.

36. QBRP Scorecards
Scorecards are mailed out at the end of each reporting period.

37. Important Dates
Period Period 2 Due no later than November 5, Due no later than May 5, 2017
Period 1 incentives will be effective January 1, 2017 Period 2 incentives will be effective July 1, 2017
November 5, 2016
January 1, 2017
May 5, 2017
July 1, 2017
Period 1 incentives are effective
Period 2 incentives are effective
Period 1 submission due
Period 2 submission due

38. Prerequisites
I attest that this facility will file all claims electronically.
I attest that this facility will accept electronic remittance advices through the ANSI 835 transaction or retrieve remittance advices from the BCBSKS website.
I attest that this facility will obtain eligibility, benefit and claim status information primarily through electronic transactions. These transactions will be accessed through the Availity interface or the ANSI 270/271 transaction to electronically obtain BCBSKS patient eligibility and benefit information. BCBSKS claim status information will be accessed through the Availity interface or the ANSI 276/277 transaction.

39. 2017 QBRP Measures Measure Description Source 2017 Incentive QM1
Prophylactic Intravenous (IV) Antibiotic Timing
CMS ASC-5
1.75%
QM2
Patient Falls within the ASC
CMS ASC-2
QM3
All-Cause Hospital Transfer/Admission
(CMS ASC-4)
QM4
Surgical Time Out Procedure
BCBSKS
1.00%
Total Incentive Possible
6.25%

40. QM1: Prophylactic Intravenous (IV) Antibiotic Timing (CMS ASC-5)
Numerator: Number of ASC admissions with an order for a prophylactic IV antibiotic for prevention of surgical site infections (SSI) who received the prophylactic antibiotic on time
Denominator: All ASC admissions with a preoperative order for a prophylactic IV antibiotic for prevention of surgical site infection
Incentive: 1.75%

41. QM2: Falls Within the ASC (CMS ASC-2)
Report the number of ASC admissions experiencing a fall within the confines of the ASC.
Numerator: Falls within the confines of the ASC
Denominator: All ASC admissions
Incentive: 1.75%

42. QM3: All-Cause Hospital Transfer/Admission (CMS ASC-4)
Report ASC admissions that are transferred or admitted to a hospital upon discharge from the ASC.
Numerator: ASC admissions requiring a hospital transfer or hospital admission upon discharge from the ASC.
Denominator: All ASC admissions
Incentive: 1.75%

43. QM4: Surgical Time Out
I attest that this hospital has implemented and is consistently using a time-out protocol which requires a hard stop by all surgical staff after prep and drape and prior to the start of the procedure. The protocol shall include the following:
(a) Identification of the patient by name.
(b) The procedure is stated.
(c) The marked incision site is visible.
(d) Allergies are stated and shared with the team and selected prophylaxis antibiotics ordered and given.
(e) The team is asked about any concerns before starting. Concerns are shared with the team and discussed to mitigate risk.
Incentive: 1.00%

44.   Medical Policies
Medical Policies reflect medically necessary criteria used/developed by BCBSKS
The policies are located on the Institutional Provider page on the BCBSKS website
Medical Policies do not guarantee benefits
Policies apply to Institutional and Professional providers
All services are subject to medical necessity; please refer to the "by report" codes on your MAP listing that also are reviewed by our Medical Review staff

45.   2017 Contract Changes
In 2017, the reimbursement for CPT will be reduced to better reflect the resources required for this service. Based on additional information submitted by providers, the following procedures in the table below will be added to the ASC maximum allowable payment listing in 2017.
Please refer to the separate MAP listing included in the contracting package for the entire 2017 MAP listing for ASCs.

46. 2017 Contract Changes Overview of Policy and Procedure Changes
Overview of Policy and Procedure Payment Attachment Changes

47. Thank you for participating in today's webinar!
Questions and Answers
If you have additional questions after today's webinar concludes, please contact us at the or number below:
Janne Denton – (785)
Connie Winkley – (785)
Misty Tillman - (785)
Thank you for participating in today's webinar!