Cirius Newsletter
TABLE OF CONTENTS
Business Case Studies
Payer Spotlight-United Healthcare
CMS Update
SCORE Card for Revenue Cycle
HFMA ANI Event
Business Case Studies
University of Iowa Hospitals & Clinics reduces AR days....
 
Methodist Hospital of Dallas reallocate staff in business office....
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Payer Spotlight
United Healthcare

NPI reports on the UB-04 Claim Form

Billing Provider NPI
FL 55
Other Operating NPI
FL76
Rendering NPI
FL77
 
These fields can be used to report NPI for Referring, Other Operating, and Rendering Physician. See definitions in the UB-04 Data Specifications Manual.

UnitedHealthcare will not reject 1500 or UB-04 paper claims without NPI if there is enough information to process the request even for those states where there is a state or federal agency mandate requiring covered entities to submit this information (Example:Minnesota, Arizona Medicaid and all Medicare crossover claims).

Implementation of the NPI does not change UnitedHealthcare's corporate complete claim submission policy. NPI will not be a criterion in determining whether or not a claim is complete except in those states where there are mandates requiring submission of NPI in order to satisfy complete claim requirements.

HIPAA 835 Errors Due to Invalid Identifiers in NPI Field on Paper 1500 Claims

Invalid data has been identified in the NPI field (box 33a) on paper 1500 claims submitted to UnitedHealthcare, resulting in an claims processing (?) issue on the HIPAA 835 for some providers enrolled in this transaction. UnitedHealthcare has completed its software changes to enable use of the NPI on the HIPAA 835, in readiness for the May 23, 2007 compliance date. At this time, then, billing provider NPI information found in Box 33a for the 1500 form is directly utilized in UnitedHealthcare's production of a HIPAA 835,whether the number in the box is valid or invalid.

UnitedHealthcare is taking remediation steps to address this problem, including communications to the impacted providers and instruction to claim keying vendors not to key invalid data to the NPI field. Please review the points below for general information and our remediation steps.

Paper 1500 Forms

· Invalid identifiers in the NPI field (box 33a) on a paper 1500 form will result in a claim error on the HIPAA 835 remittance advice, such as "Value Fails Check Digit Algorithm" or "Value Does Not Match Format for the HIPAA National Provider Identifier". · Valid NPI numbers consist of 10 digit-numeric identifiers, with no alpha characters. · NPI is the only identifier to be entered into box 33a on the revised 1500 form. · Other identifiers (legacy identifiers) should be entered into box 33b of the revised 1500 claim form. · Check to make sure that your claim software supports the revised 1500 form.

 
Issue: 1 June/2007

Cirius is proud to announce a newly redesigned
website. Share in the success that our customers have experienced using Cirius Revenue Cycle Solutions. Experience using business performance improvement software with the most responsive customer support team in the industry working towards building solid and successful financial results. Once at the new website take a moment to view the new Cirius logo. The logo displays three interlocking rings with each ring representing one facet of healthcare financial software. This speaks to the Cirius organization's commitment to ensure our customer's success.
CMS Update
UB-04
June 11, 2007 Program Transmittal released updating Medicare Claims Processing Manual Chapter 25. UB-92 is no longer accepted as of May 23, 2007. Only the UB-04 is the accepted format including rebills.
Reference link:R1254CP
UPIN
CMS will discontinue assigning new UPIN's on June 29, 2007, but CMS will maintain its UPIN public "look-up" functionality and Registry website http://www.upinregistry.com through September 30, 2007. Reference link: MM5584
NPI
As early as July 1, 2007 CMS may begin rejecting Medicare fee for service claims that do not contain an NPI for the primary providers.
Reference link: MM5595Revised
 
1500 Claim Form
Beginning July 2,2007, you must use the Form CMS- 1500, version (08-05) for paper claims submissions to Medicare. Claims received on or after July 2,2007 using Form CMS-1500, version (12-90) will be rejected.
Reference link:MM5616
 
 
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SCORE CARD for Revenue Cycle
Cash
Monthly Total Cash Collections
Breakdown by payer
Cash-Percentage of payment transactions posted
electronically
Cash-Monthly revenue
Cash-Monthly Cost to Collect ratio
AR Days
Average Daily Revenue (3 months rolling average)
Percentage of Monthly A/R Goal Met
Total Days in AR (including DNFB)
Number of Accounts Greater than 90 days
Dollar amount of accounts greater than 90 days
Percentage of accounts greater than 90 days
Billing
Clean Claim Percentage
Claims transmitted (number of accounts)
Claims not transmitted (number of accounts)
Total accounts receivable billed
Coding
Dollar amount of DNFB
Average AR days in DNFB
DNFB as percentage of total AR in-house accounts
Percentage of late charges to revenue
Total of late charges per clinical department
Compliance
Dollar amount written off as a service not supported by medical necessity
Dollar amount written off to ABN issues
Credits
Dollar amount of credit balances
Number of accounts with credit balances
Credit balances as a percentage of Total AR
Contractual Allowances
Contractual Allowances as percentage of revenue
Denials
Dollar amount of total denials
Percentage of denials to revenue
Total avoidable denials (breakdown by category)
Avoidable denials as percentage of revenue
Non-avoidable denials as percentage of revenue
Average appeal success ration-duration of time
Bad Debt/Charity
Dollar amount of Bad Debt write off
Percentage of Bad Debt to revenue
Dollar amount of charity to revenue
Total uncollectible (Bad Debt & Charity)
Uncollectible as a percentage of revenue
Is your facility making the "Grade"? Find out who is making the Grade-See Client Results.
HMFA ANI EVENT
Cirius San Diego Harbor Excursion
Join us for a dinner cruise or stop by our booth #749 and enter a free raffle for a portable GPS. See you there! Website for other Cirius Events 
 
 
Cirius Group, Inc provides healthcare financial software to some of the largest healthcare organizations nationwide. Join our family of clients. We would love the opportunity to sit and chat with you about how we can help you improve your business operations. Your business is our business.
 
 
Jayne Kroner
Director Business Development
Cirius Group, Inc.