Enterprise Edition 14.8.2 Release Notes

April 23, 2014

Below are the latest updates to Enterprise Edition.

firstHOSPICE

Maintenance

●       Changes have been made to Billing to allow 3 decimal places in the CTP segment on the 837 for the Quantity.

●       Changes have been made to Tools | Medication Fills to fix an issue that was causing drugs not found in Medi-Span but found in the crosswalk file with current HCPCS to be flagged as Invalid.

Enhancements

●       Changes have been made to Tools | Medication Fills to add a new aqua flag title Missing HCPCS in Crosswalk. The flag is only triggered if for the entered NDC and Fill Date the record found in the crosswalk file for the medication has a value of None or NULL for the HCPCS. As existing behavior dictates, the medication must also not be considered: Invalid, Duplicate Fill, or Missing From Patient.

●       Changes have been made to Tools | Medication Fills to default the HCPCS field, when entering a medication fill record, if the HCPCS field is left blank AND you select the Drug Route Infusion Pump or Injectable.  Previously, the HCPCS value would be retrieved regardless of the Drug Route selection.

●       Changes have been made to Tools | Medication Fills to add two new fields: Pkg Qty and Unit Code.

• • Pkg Qty will support up to 3 decimal places

  • Unit Code will default to 'UN'

These two new fields will be used by billing to construct the 46 Description field on the claim for Non-Injectable medications and also by the 837 in the CTP loop of the 2410 to identify the Quantity and Composite Unit of Measure.

In the Unit Code drop down, you will notice the options are the appropriate bill qualifiers: UN, F2, GR, ML, and ME. Also, available are the following additional unit options for ease of data entry:  EA, GM, IU, and MG. The additional options will appropriately map on the bill creation as follows: UN, GR, F2, and ME.

You need to review each medication fill record after saving and prior to billing to ensure that the values for Pkg Qty and Unit code are set for desired billing values.

Data Entry with the New Fields:

When entering a new record, if you enter a zero or greater value in Pkg Qty, neither the Pkg Qty nor the Unit Code will attempt to default. The entered values and selections will be saved.

When entering a new record, if you leave the Pkg Qty blank and save, Enterprise Edition will attempt to default both the Pkg Qty and Unit Code based on the rules described below. Whatever selection you made to Unit Code will be overwritten if a default value is found.

Once a medication fill record has been saved you can go back to default the Pkg Qty and Unit Code fields by clearing the Pkg Qty field and saving. BOTH the Pkg Qty and Unit Code will be overwritten by the default values should a default be found. If you simply want to zero out Pkg Qty, a zero should be entered for an existing record in which case no changes other than setting to 0 will occur to Pkg Qty. Unit code will not be defaulted.

Defaulting Behavior Rules for New Fields Regardless if Medi-Span is turned on for the database:

If the drug is found in the crosswalk file, AND Drug Route Injection or Infusion Pump is selected, the Pkg Qty will default to the HCPCS Amount # 1 found in the crosswalk file, and the Unit Code will default to the HCPCS Measure # 1 found in the crosswalk file.

If the drug is found in the crosswalk file, AND Drug Route Non-Injectable is selected, the Pkg Qty will default to the NDC. The number of items in Pkg Qty and Unit Code will default to the NDC Package Measure found in the crosswalk file.

There are units of measure values in the crosswalk file which have no direct mapping to one of the 9 selections Enterprise Edition offers in the Unit Code drop down. In this scenario the Unit code will default to UN.

Defaulting Behavior Rules for New Fields ONLY if Medi-Span is turned on for the database:

If the drug is not found in the crosswalk file, and the Drug Route selection is Non-Injectable, Enterprise Edition will prefill Pkg Qty with the Packsize field in the mmw_drug_pack table and packsizeunitcode will set the Unit Code value.

Defaulting Behavior Rules for New Fields if Medi-Span is NOT turned on for the database:

If the drug is not found in the crosswalk file, no default for Pkg Qty will occur. If no value is entered for Pkg Qty, zero will be saved and Unit Code will still default to UN for all new records.

A new flag was added to the Tools | Medication Fills Screen.

A grey blue legend item titled Injection/Infusion Pump not in Crosswalk has been added. This flag is only triggered if Drug Route Injection or Infusion Pump is selected for the entered NDC and:

●       There is NO crosswalk record

●       The fill date entered does not intersect with any existing crosswalk records

As existing behavior dictates, the medication must also not be considered: Invalid, Duplicate Fill, Missing From Patient, or Missing HCPCS in the crosswalk file.

Helpful Tips for Hospice Mandate

●       As a part of the other provider NPI reporting for inpatient facility NPI numbers, claims will be required to include a 9 digit zip code or will be returned (RTP) if the information is missing. To verify that the 9 digit facility zip code is entered in Enterprise Edition, go to Master Files | Facilities and review the Zip field. If the field is blank enter the applicable 9 digit zip code for the facility.

●       Converting National Drug Code (NDC)from 10-digits to 11 digits:

It should be noted that many NDC are displayed on drug packaging in a 10-digit format. Proper billing of an NDC requires an 11-digit number in a 5-4-2 format. Converting NDC from a 10-digit to an 11-digit format requires a strategically placed zero, dependent upon the 10-digit format. The following table shows common 10-digit NDC formats indicated on packaging and the associated conversion to an 11-digit format, using the proper placement of a zero. The correctly formatted, additional “0” is in a bold font and underlined in the following example. Note that hyphens indicated below are used solely to illustrate the various formatting examples for the NDC.

NOTE: Do not use hyphens when entering the actual data in your claim.

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