Update on CGS and Palmetto GBA Issues with Home Health Claims with Episodes Crossing January 1, 2016

Agencies should be aware that CGS has indicated all Home Health Claims submitted with episodes that cross the January 1, 2016 time point which may hold HCPCS codes G0154, G0299 and G0300 are being RTP’ed with an S status or suspended.  Manual review of claims is being conducted.  No further action will be required.  CGS will notify the provider of Claims determined to be in error through the usualy channels.

Palmetto GBA has indicated all claims submitted with episodes crossing the January 1, 2016 time point will be placed in RTP with reason code  32402 or 32403.  No agency action is required at this time.  Palmetto has indicated when the issue is resolved further instructions will be provided  through their Claims Payment Issues Log.

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2016 CBSA Codes

Agencies who invoiced services  in 2015 which  required the 2015 transitional cbsa codes beginning with 500…, will need Main Office Software version 5898 dated 01/20/16.  The software update will replace the 500… code with the correct code for 2016 invoicing.

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A New PECOS File is Available

A new PECOS file is now available for download.

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Other Insurance Effective Dates for New G/HCPCS Codes Differentiating RN and LPN Visits

Available with Main Office Software Version 5893 dated 01/08/2016, additional data entry fields are now available to accommodate effective dates for the new G/HCPCS codes for RN and LPN visits for other Insurance companies.  Many of these other insurance companies will have different effective dates for use of these new G/HCPCS codes .   Agencies will find a new date field in Insurance Set Up for each Insurance Company, on the Insurance Company tab labeled “Effective date of G Codes G0299 G0300”.  Agencies will need to enter the effective date for the new G codes.

Agencies must then update their Service Setup for the insurance company with the new G Code.  The new G Code can be entered into the HCPCS field.  The update to the Service Set Up can/should  be done now, prior to the effective date.

When invoicing, the software will look at the date of the visits being invoiced.  If the date of service is prior to the effective date, the software will replace the new G Codes with Go154.  When invoicing for dates of service on or after the effective date, he software will use the new G codes already attached to the visits by complying with the previously detailed set up instructions.

ADDITIONAL SERVICE SET UP TO CONSIDER:

Agencies currently using different service codes for RN and LPN visits for the Insurance Company can update the HCPCS field with the new G code.

Agencies that do not currently differentiate in services between RN and LPN visits for the insurance company will need to update their current Skilled Nursing Visit service to reflect the RN visit and enter the new RN G Code in the HCPCS field.  Agencies will then need to add a new service for the LPN Skilled Nursing Visit using the new G code for services by an LPN in the HCPCS field.  If the agency has already added a new Service Code for the LPN visit, the agency should add the Insurance Company into the Insurance Company Billing rate tab with the Insurance company specific billing rate, billing unit, revenue code and the updated HCPCS.  The Service or Revenue code needed for invoicing these services should be verified.  Agencies that have the Insurance Company already entered in the Insurance Company Rates tab will just need to update the existing record with the new G/HCPCS code.

Agencies should contact their commercial insurance or Medicare Advantage/ HMO plans to verify if any changes are required for those payers.

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Update for 1095-C Forms

Available with main Office Software Version 5892 dated 01/07/2016, agencies now have an option to print both an employer copy and an employee copy of the 1095-C form using the new field labeled, ‘1095-C Format’.

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OASIS errors

Agencies receiving an OASIS error related to the OASIS Version when submitting xml files to CMS will need to update to the most current Main Office software version, 5891 dated 01/07/2016.  The software populated the new 2016 OASIS version for assessments completed in late 2015.  The version update will correct this problem.

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New Service Statistical Subgroups

Available with the current Main Office Software Version 5888 dated 01/04/2016, statistical subgroups have been made available for assignment in Services Set Up.   The field for the statistical subgroup can be found to the right of the statistical group field on the Service Billing Rate tab.  The statistical group for each service is still required.   For example, a service code for an LPN visit  must have the statistical group RN applied and the subgroup LPN can now also be assigned.  Historical Statistical Report, Cost Report Visit Counts & Patients can be generated to include the statistical subgroups by selecting the new check box in the report parameters screen.

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1095-C Forms

Available with Main office software version 5882 dated 12-17-15, the software now has the ability to generate 1095-C forms.  A new button is now available in the Payroll module labeled 1095-C Forms which will allow agencies to set up the required data for each eligible employee and generate the 1095-c form.  Upon accessing the 1095-C button the screen will display a list of agency employees.  Agencies must next indicate which employees will be included.  As each employee is highlighted in the grid on the left side of the screen, the check box on the right under the Employee 1095-C information labeled “1095-C needed” must be checked.  Once eligible employees are marked use the filter at the top of the screen to display only eligible employees by marking the check box ‘1095-C Needed’ and selecting the green Apply Filters button.

Each eligible employee must have the tax year populated and the Plan start month.  If this will be the same for all eligible agency employees then the date can be entered in the Posting Defaults section Tax Y/E.  Selection of the lightning bolt button will post the date to all marked eligible employees.

Each eligible employee will be required to have entered modifiers and dollar amounts for required lines 14, 15, and 16 of the 1095-C form.  Agencies will use either a 12 month default (labeled as All 12 Months in the screen) or will post the line items by individual month in the Employee 1095-C Information section of the screen.   Per 1095-C instructions if the ‘All 12 Months’ fields are used then By Month posting should not be completed.  If both fields have been entered in the software, the software will default to use the ‘By Month’ entries on the 1095-C form.

The Posting Defaults section holds data entry fields for posting All 12 Months.  The Post button will populate the same information to all marked eligible employees.  Alternatively, if the default ‘All 12 Months’ is populated in the Posting Defaults section which may be correct for some eligible employees but not all, the arrow button available beside the  ‘All 12 Months’ data entry fields in the Employee 1095-C Information section can be selected.  The software will populate the ‘All 12 Months’ data to the specific highlighted employee only.

Agencies may post the required data by individual month for marked employees.  If the default By Month data is populated in the Posting Defaults section, the arrow button may be selected next to the month in the Employee 1095-C Information section to populate the default data for that month for the employee.   The software does also allow for direct data entry into each month.

Report parameters at the bottom of the screen provide options to perform.  Ensure the Report Tax Year End is entered and matches the Tax Year entered on each eligible employee.  Under ‘Operation to Perform’ the option Listing will display the 1095-C information in listing format to allow for verification all data entry is complete and correct.  The Software provides an option to print an individual employees 1095-C form or 1095-C forms for a batch of all eligible employees.

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Software Changes for Medicare Hospice Routine Home Care Charges Beginning January 1, 2016

Agencies will need Main Office software version 5882 dated 12-17-15 or later to accommodate Routine Home Care charges for Medicare Hospice days 1-60 (High Rate) and day 61 and after (low rate) to begin January 1, 2016.  Service set up will now have a new data entry field.  Agencies will need to use their current Routine Home Care service.  NO ADDITIONAL SERVICE CODE SHOULD BE CREATED OR ENTERED IN THE SOFTWARE.  Agencies who enter and update yearly the current Routine Home Care rates in the billing rate field in the Service Billing Rate tab will need to update the billing rate field with the Routine Home Care rate for days 1-60 (high rate).  An additional field has been added under a new section “Hospice Routine Charges Posting”.  The field is labeled “Hospice Routine Charges 61+days rate.  Agencies will need to enter the Routine Home Care rate for day 61 and after (low rate).

If your agency is using the system calculated Hospice rates and the check mark is in place to “Use system calculated Hospice rates based on national payment rates adjusted for wage index”, no updates to the service set up are needed.

The software will calculate and post the correct high and low rates to the routine charge when posting Routine Hospice charges through the Billing Utility- Hospice Routine Charges.  The software will use the Start Of Care date as entered in the patient demographics screen as day one when counting hospice days for each patient.

All agencies will need to indicate if a patient used Hospice days at another agency or in a different election period within the past 60 days of the current election.  The number of days used previously must be counted and a Date entered in the Patient/Insurance/Hospice tab in the Election/Certifications/CHAPS tab to indicate when the low rate, day 61 or after should be applied to generated Routine charges using the Billing Utility to Post hospice Routine Charges.

The software will use the additional fields to calculate the anticipated invoice total and will post this invoice total when Accounts Receivable is updated during invoice or electronic claim generation process in the software.

As a reminder per Medicare requirements, both high and low routine charges will be included in the total dollar amount on the same summary line for routine charges on paper invoices and electronic claims.  You will not see line items separating the two rates.

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2016 Federal Tax Tables

The 2016 Federal Tax Tables are now available with Main Office software version 5882 dated 12-17-15.

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