Allegheny Messages

We have finished the changes needed for the CMS requirements that all PPS claims as of July 1, 2013,  include a revenue service line record showing the patient place of service information.  Any time the place of service changes for a patient CMS wants to see another revenue service line record. These changes will be available on tonight’s update, version 5268, but will not be included on claims until July 1st.

In order to accomplish these changes we recently we had added fields in the PPS Billing Information screen for OASIS assessments to indicate the initial place of service HCPCS code along with two sets of date and HCPCS code fields for changes in place of service.  (The date of the initial place of service is always the same as the first billable visit).  There are three valid options for these place of service HCPCS codes; Q5001 – patient’s home/residence, Q5002 – assisted living facility, Q5009 – place not other specified.

Since that time we have been asked to include a default initial place of service HCPCS field in patient demographics to use in case the user forgets to indicate in the OASIS billing record.  We have added that field and have placed it on the insurance tab under patients.  PPS billing will use that code of nothing has been setup in the PPS Billing Information screen for any OASIS assessment for that patient.  In addition, if no initial place of service has been established in either location we will default to using Q5001.  It will be the agency responsibility to make changes if Q5001 is not appropriate.

Following the CMS guidelines as noted above, revenue service lines with the appropriate HCPCS codes will be added to the claim to indicate the initial place of service and for any additional changes to the place of service.  The revenue code used on each of these revenue service lines need to be the same as a revenue code used on an actual visit for same day as the place of service record.  The system will look for a visit on the same day in order to obtain a revenue code.  The billing amount is to be $.01.  The units will be 1.

These additional revenue service lines will begin to appear on claims generated after July 1, 2013.  By default the place of service lines will appear for all insurance companies when doing PPS billing. If you determine that you have an insurance company that wants you to exclude them there is a new check box under Insurance / PPS to exclude PPS place of service records.