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UB04 Update
Effective February 18, 2009
Value Code A6: For use with Revenue code 637 wording changed: The amount included in covered charges for self-administrable drugs administered to the patient because the drug was necessary for diagnostic study or other reason(e.g. drug is specificity covered by the payer.)
FL12-Admission/Start of Care:
Required on all IP claim types and TOBs: 032x,033x,034x,012x,022x,x081x,082x
FL69-Admitting Diagnosis:
Required on 012x, 022x and IP claim types except 028x,065x,066x,084x,086x
Condition Code 42 -Continuing Care not Related to IP Hospitalization
Effective January 1, 2009
H2-Condition Code for discharge by a hospice provider for cause.
80-Occurrence span code for prior same-SNF stay dates for payment ban purpose.
AC-Code-Code Qualifier for Attachment Control Number
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| Aetna Rejects Claims
Important NEWS |
Providers submitting claims without NPIs
Effective March 16, 2009, to comply with HIPAA regulations, we will reject electronic claims and encounters submitted without a billing provider NPI. If a "pay to" provider is identified on a claim, the NPI for that provider must also be included.
Providers who receive Electronic Remittance Advices (ERAs)
Beginning March 30, 2009, we will only generate ERAs that are NPI compliant (2 pages). This means that if you send in paper claims without NPIs, you may not receive an ERA. Instead, you may receive a paper or online Explanation of Benefits (EOB).
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| Medicare Update
NDC Effective: July 1, 2009
Hospitals billing for drugs/biologicals that have received FDA approval but which have not yet received product-specific HCPCS codes will not only specify the NDC of the drugs/biologicals. Learn more.... MLN Matters MM6330
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NPI
Effective: March 27, 2009
Upon submission of paper or electronic Medicare claims for reference laboratory or purchased diagnostic services that are performed by a provider outside of your billing jurisdiction; you should report your own NPI in the performing provider's. Learn more...
MLN Matters MM6362 and
WEDI NPI Checklist
New Programs
Zone Program Integrity Contractor (ZPIC)
Effective: January 26, 2009 Overpayment reviews will be performed. Provider has the opportunity to submit additional information before being offered a consent settlement.
The provider or supplier has forty-five (45) days to furnish additional information concerning the medical records for the claims that have been reviewed. Learn more...CMS Transmittal 282 CR 6170
ICD-10 General Equivalence Mappings
Crosswalk from ICD-9 to ICD-10 and ICD-10-PCS
American Recovery and Reinvestment Act (ARRA)
Medicaid fund distribution found here by state:
Pilot Programs
Care Transitions Project-seeking to eliminate unnecessary hospital readmissions. Approximately 20 percent of Medicare beneficiaries are rehospitalized within 20 days, according to the New England Journal of Medicine.
Ace Demonstration Project-testing the use of a bundled payment for both hospital and physician services
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NO MARGIN- NO MISSION
As margins decrease and requirements increase on your time and resources, what can you do to meet these challenges? Put the best practice technology solutions available into the hands of your organization.
We welcome the opportunity to earn your business.
Warm Regards,
Jayne Kroner
VP, Business Development
Cirius Group, Inc.
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| Sandi Adcock, Director of PFS at Washington Hospital and Kevin Greenlaw of Cirius attend a Cirius Users Group Conference.
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| Welcome New Customers |
Sutter Health
Cass Medical Center
St.Joseph's/Candler
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| Red Flag Alert |
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What is the Red Flag Alert? IDENTITY THEFT
The Federal Trade Commission (FTC)demands healthcare providers detect, identify and take action on possible identity theft incidences.
Hospital Triggers may include-
Records showing medical treatment that is inconsistent with the patient's history; suspicious documents, such as a forged insurance card; unusual billing patterns; patient information appears to have been altered;
advisement of unauthorized charges to bank credit/debit card;
DOB or SSN should be verified on all inbound phone calls, and many more.
Effective: May 1, 2009 View FTC Ruling |
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| Revenue Cycle Metrics |
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Cost to Collect
New Best Practice for Revenue Cycle's metric Cost to Collect should be targeted at 2%. One industry leader states "Whereas the 3% best-practice target was applicable in 2005 and 2007 the industry has made great productivity gains this decade. These productivity gains have been achieved primarily by wider use of bolt-on systems."
Rev Cycle Webinar |
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