Hot topics - WPS Health Insurance

Loading...

Release 3.6 Institutional Newsletter

October 2017

Hot topics ICD-10 Updates Installed the 2017 ICD-10 Diagnosis & Procedure Codes and ICD-10 General Equivalency Mapping (GEM) files. Refer to the accompanying report for a complete listing of the new and modified codes.

Enclosed materials ••

Pre-built PC-ACE 3.6 upgrade file named PCACEUP.EXE and replacement SETUP.EXE file for any new providers

••

This newsletter

ABILITY | PC-ACE Release 3.6 Institutional Newsletter • October 2017

1

CMS mandated changes ICD-10 Updates: Diagnosis and Procedure Code Stand-Alone Files for the Fiscal Intermediary Shared System ••

Updated the Claim Adjustment Reason Codes reference file with the latest WPC published code set. Codes Added: 2; Codes Deleted/Terminated: 0; Codes Modified: 63. The new codes are (effective 7/1/2017): 281 - Deductible waived per contractual agreement. Use only with Group Code CO.

••

N794 - Payment adjusted based on type of technology used. ••

The modified codes are: N105 and N751.

CR10043 - Claim Status Category and Claim Status Codes Update Updated the Claim Status Response Codes reference file with the latest WPC published code set. Category Codes Added: 0; Category Codes Modified: 3; Status Codes Added: 4; Status Codes Deleted/Terminated: 0; Status Codes Modified: 126. ••

The modified Category codes are: E4, P3 and P4.

••

The new Status codes are (effective 7/1/2017):

282 - The procedure/revenue code is inconsistent with the type of bill. Usage: Refer to the 835 Healthcare Policy Identification...

775 - Entity Type Qualifier (Person/Non-Person Entity). Usage: this code requires use of an entity code.

The modified codes are: 4, 5, 6, 7, 8, 9, 10, 11, 12, 16, 40, 45, 49, 50, 51, 54, 55, 56, 58, 59, 90, 96, 97, 107, 108, 133, 152, 167, 170, 171, 172, 179, 183, 184, 185, 192, 219, 222, 229, 231, 232, 240, 262, 263, 264, 265, 266, 269, 278, 279, B7, B8, B15, P2, P4, P6, P8, P12, P13, P14, P21, P22 and P23.

776 - Pre/Post-operative care.

CR10040 - Remittance Advice Remark Code (RARC), Claims Adjustment Reason Code (CARC), Medicare Remit Easy Print (MREP) and PC Print Update Updated the Remittance Remarks Codes reference file with the latest WPC published code set. Codes Added: 6; Codes Deleted/Terminated: 0; Codes Modified: 2. ••

N793 - Alert: CMS is changing from the Medicare Health Insurance Claim number (HICN) to the new Medicare ...

Installed the 2017 ICD-10 Diagnosis & Procedure Codes and ICD-10 General Equivalency Mapping (GEM) files. Refer to the accompanying report for a complete listing of the new and modified codes.

CR10040 - Remittance Advice Remark Code (RARC), Claims Adjustment Reason Code (CARC), Medicare Remit Easy Print (MREP) and PC Print Update

••

N792 - Incomplete/invalid history & physical report.

The new codes are (effective 7/1/2017): N789 - Clinical Trial is not a covered benefit. N790 - Provider/supplier not accredited for product/ service.

777 - Processed based on multiple or concurrent procedure rules. 778 - Non-Compensable incident/event. Usage: To be used for Property and Casualty only. ••

The modified Status codes are: 16, 17, 18, 19, 21, 23, 24, 25, 26, 59, 60, 73, 85, 88, 89, 90, 91, 92, 93, 94, 96, 97, 106, 109, 114, 123, 124, 125, 126, 127, 128, 129, 130, 131, 132, 133, 134, 135, 136, 137, 138, 139, 140, 141, 142, 143, 144, 145, 146, 147, 148, 149, 150, 153, 155, 157, 158, 159, 160, 161, 162, 163, 164, 165, 166, 167, 168, 170, 173, 174, 175, 176, 182, 183, 252, 294, 387, 395, 402, 466, 467, 470, 480, 487, 491, 496, 499, 500, 501, 502, 503, 504, 505, 506, 508, 510, 511, 512, 514, 516, 560, 561, 562, 563, 663, 676, 677, 680, 684, 689, 693, 694, 695, 697, 700, 710, 732, 741, 743, 745, 746, 748, 754, 755, 756 and 761.

N791 - Missing history & physical report. ABILITY | PC-ACE Release 3.6 Institutional Newsletter • October 2017

2

CMS mandated changes continued… CR10044 - Next Generation Accountable Care Organization (NGACO) Year Three Benefit Enhancements

CR10167 - Revisions to the Home Health Pricer to Support Value-Based Purchasing and Payment Standardization

••

••

Added the following HCPCS codes (effective 1/1/2018): G9868 - IMAGE NEXT GEN ACO < 10 MIN G9869 - IMAGE NEXT GEN ACO 10-20 MIN G9870 - IMAGE NEXT GEN ACO > 20 MIN

CR10065 - Implementation of the Transitional Drug Add-On Payment Adjustment10041 - Exchange (CORE) ••

Added the following HCPCS codes (effective 1/1/2018): J0604 - ORAL CINACALCET ESRD DIALYSI J0606 - INJ., ETELCALCETIDE 0.1 MG

••

••

Added an institutional claim edit which requires that calcimimetics HCPCS codes J0604 and J0606 are always billed with dialysis services Modifier AX on ESRD (TOB = 72x) claims (effective 1/1/2018). Added an institutional claim edit which allows dialysis services Modifier AX to be billed on ESRD (TOB = 72x) claims only when reporting calcimimetics HCPCS codes J0604 or J0606 (effective 1/1/2018).

CR10141 - Healthcare Provider Taxonomy Codes (HPTCs) October 2017 Code Set Update Updated the Provider Taxonomy Code reference file with the latest WPC published code set. Codes Added: 2; Codes Deleted/Terminated: 0; Codes Modified: 0. ••

Modified several institutional Home Health claim edits to ensure the accurate reporting of site of service G-codes on home health visit line items.

CR10196 - Quarterly Influenza Virus Vaccine Code Update - January 2018 ••

Added the following HCPCS code (effective 1/1/2018): 90756 - CCIIV4 VACC ABX FREE IM

CR10230 - October 2017 Integrated Outpatient Code Editor (I/OCE) Specifications Version 18.3 ••

Added the following HCPCS codes (effective 8/1/2017): 0006U - RX MNTR 120+ DRUGS & SBSTS 0007U - RX TEST PRSMV UR W/DEF CONF 0008U - HPYLORI DETCJ ABX RSTNC DNA 0009U - ONC BRST CA ERBB2 AMP/NONAMP 0010U - NFCT DS STRN TYP WHL GEN SEQ 0011U - RX MNTR LC-MS/MS ORAL FLUID 0012U - GERMLN DO GENE REARGMT DETCJ 0013U - ONC SLD ORG NEO GENE REARGMT 0014U - HEM HMTLMF NEO GENE REARGMT 0015U - RX METAB ADVRS RX RXN DNA

The new codes are (effective 10/1/2017):

0016U - ONC HMTLMF NEO RNA BCR/ABL1

207WX0109X - Ophthalmology : Neuroophthalmology

0017U - ONC HMTLMF NEO JAK2 MUT DNA

207WX0110X - Ophthalmology : Pediatric Ophthalmology and Strabismus Specialist

ABILITY | PC-ACE Release 3.6 Institutional Newsletter • October 2017

3

CMS mandated changes continued… ••

0010U - NFCT DS STRN TYP WHL GEN SEQ

Added the following HCPCS codes (effective 10/1/2017):

0011U - RX MNTR LC-MS/MS ORAL FLUID

C9491 - INJECTION, AVELUMAB

0012U - GERMLN DO GENE REARGMT DETCJ

C9492 - INJECTION, DURVALUMAB

0013U - ONC SLD ORG NEO GENE REARGMT

C9493 - INJECTION, EDARAVONE

0014U - HEM HMTLMF NEO GENE REARGMT

C9494 - INJECTION, OCRELIZUMAB ••

Modified the description for HCPCS code Q9988 to read “PLATELETS PHERESIS PATH REDU”.

••

Added the following HCPCS Modifier (effective 7/24/2017):

0015U - RX METAB ADVRS RX RXN DNA 0016U - ONC HMTLMF NEO RNA BCR/ABL1 0017U - ONC HMTLMF NEO JAK2 MUT DNA ••

ZC - MERCK/SAMSUNG BIOEPIS ••

Added the following Revenue Code (effective 7/1/2017):

C9491 - INJECTION, AVELUMAB

1006 - BH R&B OUTDOOR/WILDERNESS

C9493 - INJECTION, EDARAVONE

CR10234 - Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes - October 2017 Update ••

Added the following HCPCS Modifier (effective 7/24/2017):

C9492 - INJECTION, DURVALUMAB

C9494 - INJECTION, OCRELIZUMAB CR10259 - October 2017 Update of the Ambulatory Surgical Center (ASC) Payment System ••

ZC - MERCK/SAMSUNG BIOEPIS ••

Added the following HCPCS codes (effective 8/1/2017):

Added the following HCPCS codes (effective 10/1/2017): C9491 - INJECTION, AVELUMAB

Modified an existing institutional claim edit such that it now requires either Modifier ZB or ZC when billing HCPCS code Q5102.

C9492 - INJECTION, DURVALUMAB C9493 - INJECTION, EDARAVONE

CR10236 - October 2017 Update of the Hospital Outpatient Prospective Payment System (OPPS) ••

Added the following HCPCS codes (effective 10/1/2017):

C9494 - INJECTION, OCRELIZUMAB ••

Modified an existing institutional claim edit such that it now requires either Modifier ZB or ZC when billing HCPCS code Q5102.

0006U - RX MNTR 120+ DRUGS & SBSTS 0007U - RX TEST PRSMV UR W/DEF CONF 0008U - HPYLORI DETCJ ABX RSTNC DNA 0009U - ONC BRST CA ERBB2 AMP/NONAMP

ABILITY | PC-ACE Release 3.6 Institutional Newsletter • October 2017

4

Installing the upgrade Perform a full PC-ACE database backup before installing the upgrade. To install the new upgrade, run the attached PCACEUP.EXE file using Windows Explorer or equivalent and follow the simple upgrade wizard steps. When prompted, enter the upgrade password provided by your software supplier. For networked instructions, it is recommended (but not required) that the update be run from the server’s console. IMPORTANT: The recommended database backup is for safety purposes only, and should NOT be restored after successfully installing the update. The update program preserves all existing claims and reference file settings

About ABILITY® ABILITY Network is a leading healthcare information technology company helping providers and payers simplify the administrative and clinical complexities of healthcare through innovative applications and data analytics. ABILITY is headquartered in Minneapolis with principal offices in Boston and Tampa. © 2017 ABILITY Network Inc. All Rights Reserved. ABILITY | PC-ACE Release 3.6 Institutional Newsletter • October 2017

888.460.4310 abilitynetwork.com 5

Loading...

Hot topics - WPS Health Insurance

Release 3.6 Institutional Newsletter October 2017 Hot topics ICD-10 Updates Installed the 2017 ICD-10 Diagnosis & Procedure Codes and ICD-10 General...

120KB Sizes 3 Downloads 21 Views

Recommend Documents

Health Information Technology Hot Topics - HEALTHeLINK
Four County Management. Greater Rochester IPA. Health Information Alliance of Syracuse. Hudson Information Technology fo

Technofest | Hot topics: achieving excellence | Hot topics | BP Careers
Every year across BP offices around the world, challengers and interns have the opportunity to showcase their work to th

JILBAB HOT - trending topics
Tindakan selanjutnya akan dilakukan koordinasi serta memanggil orang tua dari kedua belah pihak (pelaku). Yang jelas kam

Hot Topics - Brooks Equipment
in accordance with NFPA 10, Standard for Portable Fire Extinguishers. The technician examines the ... On July 3, 2016, a

hot topics - IEEE Computer Society
Oct 25, 2016 - Perspectives from the Practitioners. > A Call to Action to Prepare the. High-Performance Computing Workfo

FICTURE HOT ASHANTI - trending topics
Penggunaan tersebut dimaksudkan sebagai alat pendidikan untuk mengingatkan dan meningkatkan kegiatan gerakan pramuka ses

Hot Topics - City of Vallejo
Jun 9, 2017 - Housing Authorities of the Cities of Berkeley, San Francisco,. Richmond, and ..... Family Self-Sufficiency

VIPER® Health Insurance | COBRA Health Insurance Alternative
Affordable Health Insurance Solutions & COBRA Alternatives VIPER Health Insurance Free no-obligation quote! In today's w

COBRA Health Insurance Coverage Continuation Law | HR Topics for
COBRA Health Insurance Coverage Continuation Law: COBRA rules and regulations, COBRA stimulus package subsidy, COBRA not

Daman Health Insurance - Dubai Health Insurance
Here is a list and a basic description of Daman's health insurance models: Premier Plan: with an annual limit of 5 milli