Main Office software version 6434 dated 01/30/2019 will include a FIPS code for all Medicare PPS claims (RAPs and Finals). The FIPS code will also now be included on the Print form of a paper UB04 when generated from PPS Billing.

A new Override to remove the new FIPS, Value Code 85 from PPS Claims for Commercial Insurances not requiring the value code has been added with Main Office Software version 6422 Dated 01/17/19. The Override can be found in Insurance/PPS tab labeled ‘Exclude FIPS Value Code 85′. The override will remove the new value code for Insurance companies requiring PPS style billing but not requiring the new value code.

Agencies who have received claim rejections for Value code 85 on PPS claims with date of service prior to January 1,2019 will need main Office software version 6420 dated 01/16/19 or later. Prior software versions placed the new Value Code in 2018 PPS Claims causing rejections. Software version 6420 will correct this issue.

Main Office Software version 6419 dated 01/15/2019 will correct a Validation Report warning some agencies are receiving for submitted HIPPS code does not match the calculated HIPPS code upon xml file submission. A correction has been made to the point calculation in the Clinical domain. Typographical errors in the PPS Summary sheet have been completed in the Functional domain.

Main Office software version 6408 dated 01/07/2019 will include the new requirement for Value Code 85 with corresponding FIPS code for Rural CBSA codes in Medicare PPS electronic ANSI 837I Claim files. The Value code and FIPS code will populate automatically based upon the current county set in the software.
Please note: The new Value code will not be included on the print form of the paper UBO4 generated for agency records at this time but is present in the ANSI claim file.

Pennsylvania agencies submitting reports to HHA EXchange to meet the EVV requirements should have Main Office Software Version 6380 dated 11/07/18. The update will include an additional check box in the ANSI 5010 Billing screen when marking the check box to ‘Create an HHA Exchange csv after report prints’ to also mark the ‘V4′ check box. The V4 is the latest output format version that is currently required.

Agencies will need Main Office Software Version 6362 dated 10-01-18 prior to submitting any OASIS XML files to CMS for OASIS Assessments with a M0090 date of 10-01-18 or later to ensure the updated HIPPS Version is applied.

Agencies must ensure they are using Main Office Software Update Version 6359 or later and Clinical Point of Care Software Users must have Version 2728 to receive the updated ICD 10-CM code set that will be effective as of October 1, 2018.
The stated version updates will also include the new Grouper Version for OASIS due to the ICD 10-CM code set update.

As finalized in Medicare Program FY 2019 Hospice Wage Index and Payment rate Update and Hospice Quality Reporting Requirements rule in the Federal Register and Medicare Change Request 10573, Hospice agencies will no longer be required to submit details of Hospice medication refills. A summary line item for specific revenue codes is still required. Although, Agencies may still choose to submit detailed medication refills on claims without fear of claim denial.
Injectable medication refill reporting with revenue code 0636 in detail or summary on claims IS NO LONGER REQUIRED.
Non-injectable medication refill reporting for revenue code 0250 is required as a summary line item on claims with the total for the invoicing period. HCPCS or NDC codes will not longer be required. Agencies may continue to import non-injectable medication through the Hospice medication import for continued detailed claim reporting.
IV Pump and IV Pump Medication refills for revenue codes 0294 and 029x will be required as a summary line item on claims. Detailed reporting o f IV pump and IV Pump medication refills on a hospice claim will not be cause for denial.
Agencies are recommended to work with their administration and the agency Hospice Pharmacy related to determining a practice continuing detailed medication refill reporting or a change to summary line items on claims.
Agencies who have determined to report summary line items for non-injectable medication refills, IV Pump and IV pump medication refills will continue to add a Billing Sheet (Hospice Drugs) in the patients activity screen to record a line item entry summarizing the totals for each of the three revenue codes as applicable for each invoice period.

Anew PECOS file is available for download.

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