Just recently, some of the Medicare HMO’s and other insurance companies that do not use PPS billing have asked that the HIPPS code be added to the UB04.  Most have made this a requirement as of July 1, 2013 billing; several have stated that they will not start the edit checks until September.  Most of our agencies were surprised at how little advanced warning they were given.

Version 5285 available tonight will include this feature.  To add HIPPS codes to the UB04 or ANSI 5010 billing there is a new check box under Insurance / UB04 / Services and Supplies labeled “Show HIPPS code on invoices / ANSI 5010.”  There is also another field to designate if you want the dollar amount to be $0.00, $0.01, $1.00.  Our experience with the HIPPS codes in PPS billing shows us that it will differ by insurance company.  In addition, in ANSI 5010 billing we are defaulting to units of ’1′ to eliminate possible rejections.  Some insurance companies software will not accept units of ’0′.

Adding the HIPPS code is somewhat cumbersome in that agencies will be billing by the week or month independent of OASIS assessment certification periods, that could start or end in the middle of the week or month.  In addition the OASIS could be dated before the beginning of the billing period and would reject if we used that date on the invoice or in the file because the date is outside of the billing visit date range. The insurance companies have stated they want the HIPPS code to show first on the invoice which is another factor.  We made the decision that system will always list the HIPPS code on the invoice first using the same date as the first billable visit.

What the system will do is look for the most recent OASIS assessment with a SOC or completion date that is prior to or within 5 days of the first billable visit of the invoice.  For now the system will ignore OASIS assessments that may occur beyond five days after the first visit on the invoice.

There are other insurance company specific factors that could cause problems with the ANSI 5010 billing.  We will address these as they arise.  Thanks in advance for your support as we deal with these new challenges.

We have very recently been notified that as of July 1, 2013, Medicare Advantage Plan claims need to include an OASIS HIPPS code record.  Medicare Advantage claims are usually billed electronically under the ANSI 5010 billing.  What we plan to do is add a check box somewhere in Insurances that the user wants the OASIS HIPPS code included on the claims.  If checked, when the claim is created the system will search OASIS records to obtain the appropriate HIPPS code.  We plan to compare the first billable visit of the claim with the certification period of the OASIS in order to select the correct OASIS assessment.  We plan to have these changes completed by the end of this week.  We will give specifics when the changes are complete.

It is our understanding that the electronic edit checking will not take place until September but we are not sure all plans will wait till then.

Users can now define unique patient types as found in patient maintenance.  The can be added in Other-Setup in the Misc. Setup tab.

In the past users have had problems with notes in the patient or employee maintenance sections accidentally being deleted.  We have also had requests to tighten the security on these fields.  In the latest update the fields can no longer be changed unless the new “Edit” button beside these notes is pressed.  If employees do not have security to make changes to notes, the “Edit” buttons will not appear.

We have added the same type of features to the billing collection notes.

We originally changed all PPS billing to include the patient place of service HCPCS code records with billings beginning 7/1/2013.  We have changed the PPS billing to add these records only if the episode period begins 7/1/2013 or later.

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