Enterprise Edition 14.7 Release Notes Enterprise Edition 14.7 Release Notes
March 27, 2014
Below are the latest updates to Enterprise Edition.
firstHOMECARE & firstHOSPICE
Maintenance
● Changes have been made to Patient | Referral to fix errors that were occurring when a patient’s name suffix was entered in the Suffix field, causing claims errors with Medicare when the patient’s name did not match the common working file.
firstHOMECARE
Enhancements
● Changes have been made to Louisiana Medicaid claims to contain the Admission Source code “3” for claims.
Maintenance
● Changes have been made to Oklahoma Medicaid claims to contain a TOB frequency of 1 (3X1) to be in compliance with HIPAA 5010 Guidelines.
firstHOSPICE
As a result of CMS Change Request 8358 for changes in Medicare claims processing, changes have been made to be in compliance with new requirements:
Hospice staff provided GIP (general inpatient) visit reporting
Claims will be required to report line-item visits provided to patients receiving general inpatient care only by Hospice employed personnel. Claims must include visits by all billable disciplines of service, include visits provided to patients in billable GIP locations, and must be reported in 15-minute increments.
CMS is not changing the existing general inpatient visit reporting requirements when the site of service is a hospice inpatient unit; which is the site of service HCPCS code Q5006. If level of care equals GIP and HCPCS code is Q5006 reporting shall remain on a weekly basis. If a patient is receiving GIP care in any facility other than a Q5006 facility, they should be reporting their visits in hours, not using the Qty field in Productivity.
To prepare: Please confirm that Service Detail information for a general inpatient visit under Service Master is setup correctly. Most Hospice providers will already have this setup to meet current billing guidelines and if so no changes are needed.
Other provider NPI (National Provider Identifier) reporting
Claims will be required to report inpatient facility NPI number, name, and address when the facility is different than the provider submitting the claim and must include claims billed with inpatient locations. Claims will be returned (RTP) if the inpatient facility identifying information is missing.
To prepare: Verify that all of your facility records, under Master Files, contain an NPI number and address. Also, verify that the Level and Location of Care is entered on the patient’s chart. Enterprise Edition will then pull this information to the claim when the patient is receiving hospice services from a facility other than your own.
Post-mortem visits
Claims will be required to report post-mortem visits when occurring on the day of death after the time of death and must include visits performed by Hospice employed nurses, aides, social workers, and therapists. They must be reported in 15-minute increments; include a modifier code PM; and have split visit billing if death occurs during the visit. They will exclude visits occurring after the time of death on a day other than the death.
New Process: Date and time of death must be entered into the system on the Discharge screen in order for Enterprise Edition to populate the PM modifier on the detail item. Enterprise Edition will split any visits which begin before the time of death and end after the time of death into 2 detail items on the claim, and populate the modifier on any postmortem detail items with PM, with no additional data entry required of the user.
Injectable Drug Fills
Claims will be required to report injectable prescription drugs with a line-item reporting on the claim per fill, a revenue code 0636, an applicable HCPCS code, applicable units representing the amount filled based on the drug and HCPCS definition, and a charge amount. Medication fills will be entered in Enterprise Edition from a report received from the PBM/Pharmacy Management System/Pharmacy.
New Process: A medication fill screen has been added under Tools enabling you to key in the data elements necessary to fulfill the mandate. This screen will allow you to enter multiple medication fills for each patient.
● Medication fill entries must contain an 11 digit NDC code entered in standard XXXXX-XXXX-XX numeric format. Use leading zeroes in any of the three sections if your NDC code has fewer than 11 digits; for example: if your NDC is 1234-123-1, enter it as 01234-0123-01. Entries without an NDC code will NOT be saved.
● Compound medications must be linked utilizing a prescription or linkage number. We have provided a field to document the prescription or linkage number. The fill date is also used for linkage. Compound drugs are determined by having the same prescription number and fill date.
● If Enterprise Edition finds invalid NDC codes, duplicated fill information, or medications that are missing from the patient’s medication list it will alert you by color coding the entry line.
● A blank or zero charge in the Charge Amount field will result in billing errors in Download Claims.
Non-Injectable Drug Fills
Claims will be required to report infusion pumps with a line-item reporting on the claim per each pump order and per medication refill, using revenue code of 029X for the equipment (0290 General Equipment Classification, 0291 Rental, 0292 Purchase of New Equipment, 0293 Purchase of Used Equipment, 0299 Purchase of Other Equipment) and 0294 for the drugs, an applicable HCPCS code, applicable units, and a charge amount.
New Process: A medication fill screen has been added under Tools enabling you to key in the data elements necessary to fulfill the mandate. This screen will allow you to enter multiple medication fills for each patient.
● Medication fill entries must contain an 11 digit NDC code entered in standard XXXXX-XXXX-XX numeric format. Use leading zeroes in any of the three sections if your NDC code has fewer than 11 digits; for example: if your NDC is 1234-123-1, enter it as 01234-0123-01. Entries without an NDC code will NOT be saved.
● Compound medications must be linked utilizing a prescription or linkage number. We have provided a field to document the prescription or linkage number. The fill date is also used for linkage. Compound drugs are determined by having the same prescription number and fill date.
● If Enterprise Edition finds invalid NDC codes, duplicated fill information, or medications that are missing from the patients medication list it will alert you by color coding the entry line.
● A blank or zero charge in the Charge Amount field will result in billing errors in Download Claims.
Infusion Pump/Fills
Claims will be required to report infusion pumps with a line-item reporting on the claim per each pump order and per medication refill, using revenue code of 029X for the equipment (0290 General Equipment Classification, 0291 Rental, 0292 Purchase of New Equipment, 0293 Purchase of Used Equipment, 0299 Purchase of Other Equipment) and 0294 for the drugs, an applicable HCPCS code, applicable units, and a charge amount.
New process:
● Verify and enter the infusion pumps as DME. In Hospice mode, go to Master Files | DME Vendors | DME.
● Enter infusion pumps into Service Master by adding service type DME; set Discipline to blank. Once you have created the infusion pumps in Service Master, click Edit Details and enter the appropriate Rev Code (029x) and Fees, as a daily rate. Click the Infusion Pump check box to select it, which will then allow for Enterprise Edition to pull the information to the claim.
● Once the infusion pump DME has been entered in the patient’s chart you will need to choose a Service for the cost to be associated with the infusion pump.
● If you choose to override the Unit Price per patient remember that once you’ve used the Unit Price Override this will be the patient’s default even if you change the Price in Service Master.
● The delivery date of the infusion pump must be populated for Enterprise Edition to know to include it on the claim. You will NOT have to enter these charges in Charge Entry. When a drug fill is indicated as an infusion pump drug it will automatically pull the infusion pump to the claim. Once the pump is no longer being utilized, a pick up date will need to be entered in order for the information to no longer pull to the claim.
CHC Visit Reporting Incorrect
When a visit with a Skilled Service crosses a single midnight during a Continuous Home Care Period for a patient, the hours for the visit will be split across the two days appropriately and reported as separate 652 line items on the bill, each with the appropriate service date.
For this case, the single visit line items below the 652 entry will only appear once with the Service Date of the Start Date of the visit. If the visit crosses a period past midnight where the CHC coverage doesn't exist, those hours past midnight will not count towards the 652 Line Item.
Note: Only visits that span a single midnight (i.e. Start Date and Stop Date represent at most two days) are handled, visits spanning more than one midnight will cause the claims to not generate correctly and should be separated.
HHA Visits not added to 0652 Service Units on UB04
When Billing for CHC and Visits exist performed with Services that have Skilled selected on the Service Detail, these will be included in the Service Unit total 652 Line Item on the UB04 Bill.
Enhancements
● Changes have been made to Colorado Medicaid Room & Board claims to add the Service facility assigned to the patient’s Level of Care screen information in Loop 2310E.
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