| Reimbursement |
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Section 1011
Squeeze reimbursement from every source. Here are some of the current guidelines for uninsured patients.
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| Customer Corner |
CIRIUS
eLearning Available!
Reports
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| Payer Billing Tidbits |
Anthem BX Encourages providers to submit their disputes on the Provider Dispute Form. This form will ensure that your dispute is quickly acknowledged and routed to the Grievance & Appeals Department for resolution. Forms can be found on Athem's webiste. Here is a direct link-> .
AETNA is determining when a patient has an Aetna Medicare plan. To help providers distinguish Aetna Medicare patients from other Medicare patients, the member identification (ID) number will always begin with "ME".
United Health
Consistent with UH efforts to align with third party sourcing; they will be enhancing their CCI Editing Policy as related to the modifier override status. If the NCCI has determined that no modifier override is clinically
appropriate for a column one/column two code pair edit
that has historically been allowed with a modifier override via the Rebundling Policy, the CCI edit as developed and published by CMS will supersede, meaning that the modifier override will no longer be permitted.
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Healthcare Financial Newsletter
eNewsletter |
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1500 Claim Changes
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January 13, 2009
The National Uniform Claim Committee (NUCC) has released the revised NUCC Data Set and a 1500 Claim Form Map to the X12 837 Health Care Claim: Professional transaction (1500-837P Crosswalk) for use by the industry in converting paper claims to electronic transactions. Both documents are available below. User's will need to refer to the NUCC's 1500 Reference Instruction Manual for more specific information on the 1500 Claim Form and the X12 837 Health Care Claim: Professional 4010A1 implementation guide for more information on the electronic transaction.
1500 Change Log>>
1500 Instruction Manual>>
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Cirius Newsletter
January/2009
Issue: 6 |
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Dear Denise,
A slump in cash flow coupled with deep economic cost cutting is sweeping across the nation at every hospital and physician office. Be bold and swift in managing this new financial landscape.
An organic approach to consider in the Revenue Cycle is building and recognizing the value of creating an internal Revenue Integrity group. While dollars owed by the uninsured are largely outside of your control, building a strong Revenue Integrity group will enhance your ability to bill and collect every penny owed by insurance payers.
Revenue Integrity groups include responsibility for charge capture audit, internal audit, revenue reconciliation, chargemaster control and hospital wide coding - each area can benefit from scrutiny and improvement. Often, these groups analyze performance by monitoring and benchmarking and by tracking compliance of MACs, managed care contracts, state and federal regulations, which alone are daunting tasks. Assure increased compliance with agencies such as Medicare & Medicaid contractors, HHS Office of OIG while proactively pursuing entitled payments for all claims.
Expect measurable outcomes with decreased administrative and technical claim denials, ability to standardize pricing transparency, coding and policy compliance, education in other departments and most importantly increasing financial margins. Revenue Integrity groups may break down barriers between facilities and departments, ensuring communication lines stay open so the claims flow process performs as efficiently as possible and enables the drive to pursue entitled payments and streamlines the claim flow process. |
| Professional Group Claim Management |
Baylor College of Medicine -New Cirius Customer
Happy New Year! Cirius Group welcomes BCM as the first 2009 customer to go live with our Professional Fee Claim Management solution.
For 2009, U.S.News & World Report ranked BCM 13th overall among the nation's top medical schools for research and 7th for primary care. BCM also is listed 13th among all U.S. medical schools for National Institutes of Health funding, and No. 2 in the nation in federal funding for research and development in the biological sciences at universities and colleges by the National Science Foundation.
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| Medicare Speaks |
ABN Update
Effective March 1, 2009 hospitals will be required to use the new ABN-R-131. The overall process of giving an ABN has not changed. View changes here>>
CMS RAC ATTACK
FY 2009 Medical Records Limitations placed on RAC contractors for Inpatient Hospital, IRF, SNF, Hospice, Outpatient Hospital, Home Health, Physicians, DME, Lab
ACE Demonstration
The goal of the Acute Care Episode (ACE) demonstration is to use a bundled payment to better align the incentives for both hospitals and physicians, leading to better quality and greater efficiency in the care that is delivered. The demonstration will also test the effect that transparent price and quality information has on beneficiary choice for select inpatient care.
MAC Jurisdictions changed
CMS will assign new workload numbers for the MAC Jurisdictions. As such, new numbers are required to identify the work being performed by the new MAC contractors. To date, new numbers have been issued for the state of North Carolina Part A&B.
The final five Part A and Part B MAC contractors will immediately begin their implementation activities and will assume full responsibility for the claims processing work in their respective jurisdictions no later than March 2010. During the implementation period, the Part A and Part B MAC contractors will be conducting extensive outreach to health care providers, state medical associations and beneficiaries in their jurisdictions to provide education and information about the implementation.
Read more>>
NCCI Edits Change
CMS reinstates the inclusion of review of all E&M, anesthesia and mental health code pairs effective for outpatient service dates after January 1, 2009.
Telehealth Service Sites Expand
As of January 1, 2009, eligible originating sites for payment of telehealth services will include hospital based or CAH based renal dialysis facilities, SNF's and community health centers.
New Update 5010 and ICD-10-CM/PCS
Federal Register Final Rule released with confirmed date summary:
4010A1 is the HIPAA X12 transaction standard from 2003 through 12/31/2011.
5010 is the HIPAA X12 transaction standard beginning 1/1/2012.
During the period from the effective date of the rule (about March 16,2009) through 12/31/2011, either 4010A1 or 5010 can be used.
Compliance date for ICD-10 is October 1, 2013
Inpatient Medicare Part B claim requirement change
CMS manual is revised to specify that providers must submit implantable devices on a 12X type of bill, reporting a new HCPCS code (C9899) that will be effective for services furnished on and after January 1, 2009, when they furnish an implanted prosthetic device to a Medicare beneficiary:
Who is a hospital inpatient, but who does not have Part A coverage of inpatient services on the date that the implanted prosthetic device is furnished.
By reporting the new C-code, the hospital is reporting that all of the criteria for payment under Part B are met as specified in the Chapter 6, Section 10 of the Medicare Benefits Policy Manual.
MM6050>>837I Claims related to Rendering Physicians/Practitioners
CMS requires an analysis by FISS, CWF and NCH involved with the storage of rendering physician/practitioner information.
All physician/practitioner identifying information on all institutional inpatient/outpatient claims related to the rendering physician/practitioner at the claim level, identified as "other provider' must be carried through FISS and CWF to NCH. There is a need to meet the HIPAA requirement when completing 2310 loop on the 837I claim. CMS Transmittal 406>> |
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| Managed Care |
"LOST" DOLLARS - NO ISLAND PARADISE
LOST Dollars due to inaccurate healthcare insurance payments for hospital ranges on an average from three to eight percent for HMO's, PPO's and all third party payers. While this is not a new concept in the healthcare industry current economic pressures demand more focus on identifying and collecting every LOST dollar available. Accurately identify underpayments with technology then proactively seek payments on potential LOST DOLLARS. Simple and easy with an outcome that will cut costs and increase cash flow.
Now is the time to invest in the future and technology that will improve you third party negotiating power, accurately calculate receivables for government and third party claims and support your collect efforts by identifying payment variances and producing the data and documents you need to appeal and collect them. With solid technology and dedication LOST dollars can be found and recovered easily with a minimal investment(especially when compared to the 3 to 8 percent of your net revenue they cost you today). In fact, most facilities can recover their investment with 3 to 6 months of implementers LOST dollar recover plan based on solid technology and procedures.
Cirius Group has the technology you need to virtually eliminate LOST dollars and they integrate seamlessly with other Cirius Revenue Cycle technology. Cirius can help you collect those LOST dollars with additional staff resources.
Simple and Easy. Cut your Costs and Increase Cash Flow. Call or Click today to start finding your LOST dollars-your 'island paradise' is closer that you think.
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UB04 Revision Calendar
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Effective January 1, 2009
FL 18-28: New Condition Code for discharge by a hospice provider for cause (H2)
FL 35-36: New Occurrence Span Code
Prior Same-SNF Stay Dates
for Payment Ban Purposes (80)
FL 81: New Code-code qualifier for attachment control number (AC)
Removal of Note from Revenue Code Category 091x
UB04 Change Calendar
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Cirius Claim Management solutions achieve BEST PRACTICES with REAL RESULTS.
Manual Bill Touch Rate less than 15%
First Pass Pay Rate of 98%
Claim Cost Reductions by 50%
Cash Flow Improvement of 20%
Establish and maintain 2% or less Denied Claim Rate for all payers.
But don't just take our word for it, see REAL CUSTOMER RESULTS.
Allow us the opportunity to earn your business.
Jayne Kroner
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