Update for CBSA Codes for Agencies whose Medicare Intermediary is CGS

Agencies with Medicare Intermediary CGS will need to update the Main office software to version 5699 released 03/12/15.  2015 Transitional CBSA Codes will be utilized for Medicare claims.  Software changes were made previously to accommodate the Intermediary’s use of 2015 CBSA Codes.  The Intermediary has now converted its systems for use of the 2015 Transitional CBSA Codes.  If your agency has received claim rejections due to the CBSA Code, please update the Main office software to version 5699 and recreate the claim for submission which will attach the 2015 Transitional CBSA Codes.  If an urgent Medicare claim is required for submission prior to the ability to update the Main office software, agencies may select the check box “Use Transitional CBSA on 2015 claims”.  The check box can be found in the PPS tab in the Insurance data base when the applicable Insurance record is displayed.  Claims may then be recreated and submitted.  The check box will no longer be required after updating to Main office software version 5699.

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New Documentation Field for a Clinical Summary for 2015 Home Health Face to Face Encounters and Recertifications

Available with the current software versions in both the Main office and Clinical Point of Care Software, an additional tab screen has been added to the 485 Plan of Care and Physician Order (Special Type Face to Face Encounter).  The new tab is labeled Home Health Eligibility for agencies wishing to provide documentation of a Clinical Summary for the Certifying Physician to incorporate into their medical record to assist in meeting documentation requirements for the Medicare 2015 Face to Face Encounters.  Documentation will print on the 485 Plan of care and Physician Order/Face to Face Encounter under a heading “Clinical Summary/Recertification need and Duration.  As defined by the heading Home Health Agencies may also use the Eligibility tab to include a Recertification summary identifying a patient’s continued need and anticipated duration of services.

Agencies utilizing the Clinical Point of Care software will also have available for use the ‘Import (CA) Narrative’ button found on the Home Health Eligibility screen.  Documentation by a Clinician of a Clinical Summary, 60 Day Summary, Recertification need and duration, entered in the Narrative screen in Comprehensive Start of Care, Recertification, and Resumption of Care used as a Recertification assessment can be Imported to the Home Health Eligibility screen without a need to re-key the documentation.  Import is completed by selecting the ‘Import (CA) Narrative’ button.  A secondary screen will display by date Start of Care, Recertification, and Resumption of Care Comprehensive OASIS Assessments.  Select/highlight the date and activity then select the Import button.  The Documentation specific to the Narrative field in the Narrative screen will populate the Home Health Eligibility tab.

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‘PPS What If’ Update

The ‘PPS What If’ tool available for PPS Billable OASIS Assessments in the Main office software has been updated to reflect the changes for OASIS C1- ICD9 with Main Office software version 5693.

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PECOS

A new PECOS file is available for download.

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Medicare Hospice Claims with KX Modifier and Hospice Non-covered Days due to Late Notice of Election

Hospice agencies reporting Non-covered days/units with Condition Code 77 due to late Notice of Election and utilizing the KX Modifier to file for an exception will see their billing claim files Returned to Provider (RTP).  Medicare is requiring the Non-covered days and total dollar amounts reported to also include the total number of non-covered units.  All covered charges will include the total number of units and dollar amounts.  These will be reported on separate lines with in the electronic ANSI 837 claim file.  However with in the ANSI 5010 Standards for 837 files, there is only one place to report total units.  The software will include the total number of Covered units in the electronic file.  Due to the ANSI 5010 Standards for 837 files, Allegheny Software is unable to make a software change to the 837 file to report the Non-covered units, nor will Medicare accept an 837 claim file modified to include these non-covered units.  Agencies will need to manually enter the Non-covered units with in the FISS System upon receipt of the Return to Provider (RTP).

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Update for CBSA Code Values for Medicare PPS Billing

Agencies creating Medicare PPS Billing claims will need to update to Main Office software  version 5676.  Updates have been made to the CBSA Code values.  We have been notified the 2015 Transitional Code Values as previously indicated will not be used for Medicare PPS claims.  The software will begin to utilized the 2015 CBSA Code value with update 5676 which will allow claims to be processed without errors.

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Update to Correct Medicare Final Claims

Agencies receiving errors on Medicare Final Claims created with software version 5668 will need to update the Main office software to Version 5669.   Main office software version 5669 will correct the error in Medicare Final claims.

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Hospice CAHPS Survey Update

The ability to generate Hospice CAHPS Survey files based upon data entered in the Patient database/Insurance button/Hospice tab/CAHPS tab will be available with the software version update released at the end of the business day today, 2/09/2015.

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Update for Admission, Discharge and Referral Reports

Agencies utilizing the sever based Main office software whose Referral, Admission and Discharge reports are generating with no information, will need to update the Main office software with the software version released at the end of the business day today, 2/54/2015.  This version will correct and generate the reports with the requested data.

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Update for OASIS C1 Prompt for OASIS Only Assessments

At the end of the business day today 2/2/2015, a new software version will be available to restore the OASIS C1 prompt when initially adding OASIS Only Assessments in the Main office software.  The prompt will ask, ‘Is this a 2015 OASIS C1 assessment?’ with response option of Yes or No.  A response of ‘Yes’ will cause the software to display an OASIS C1 document.  A ‘No’ response will cause the software to display an OASIS C document.  The OASIS C1 prompt will be available until March 1, 2015.  After March 1, 2015 the software will default all OASIS Only Assessments added in the main office software to OASIS C1.

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