Long Term Care Billing Tips and Best Practices: Session 1 - Medicare Hot Topics

AUDIO CONFERENCE

Date/Time:

Sept. 12, 2017, Noon – 12:30 p.m. Presenter:

Andrea Hagen, MBA Director

Beacon Solutions Group, A Division of the Bonadio Group

Packet Contents: • Handout • Credit Instructions • Evaluation/Credit Form

Dial-In Instructions:

Conference Phone Number: 1-888-585-9008 Participant Access Code: 379-001-833 #

You may dial the toll-free number no sooner than

five minutes prior to the program.

LeadingAge New York/FLTC 13 British American Blvd. Suite 2 Latham, NY 12110 518.867.8385

Lunch and Learn: Medicare Hot Topics, Best Practices and

Billing Tips

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Discussion Points • FISS RTP/Corrections

• Credit Balance Reporting

• Therapy Services

• Additional Development Request

• Triple Check

• Information Only and No Payment Billing

• Medicare Beneficiary Identifier

FISS RTP/Corrections

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FISS RTP/Corrections • After a batch of claims has been submitted electronically Review 277 reports from the clearinghouse to identify upfront

rejections. Correct and resubmit.

• Approximately one week after submission review FISS errors that have been Returned to Provider (RTP). From FISS Main Menu – Type 03 and Enter

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FISS Claim RTP/Corrections • On Claim and Attachments Correction Menu (MAP 1704) Select appropriate claim type

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FISS Claim RTP/Corrections • Claim Summary Inquiry screen (Map 1741) appears

• S/LOC field will default to T B9997 (RTP file)

• Type in NPI (hold down Shift/ key and press Tab key to move to NPI field)

• TOB field displays the first 2 digits of the default TOB base on the claim correction option you selected

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FISS Claim RTP/Corrections • 050 Returned to Provider Report

Status/Location TB9997

Available on-line for 5 days

Use report to identify reason code(s) for the returned claims

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FISS Claim RTP/Corrections • The DDE SORT field allows you to sort claims for correction.

Especially helpful if you have a large number of claims to correct

Type To Sort By D Receipt Date

H HICN

M Medical Record Number

N Last Name

R Reason Code

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FISS Claim RTP/Corrections • Error reason code – F1 will access narrative which provides

information about what needs to be corrected

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FISS Claim RTP/Corrections • Suppress claims that won’t be corrected in FISS

• Action cannot be reversed

• Suppressed claims (S/LOC: I B9997) will appear when viewing claims in Claim Summary Inquiry screen (option 12) or Claim Count Summary (option 56) in S/LOC T B9997 for several weeks until FISS purges suppressed claims to the “I” status

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FISS Claim RTP/Corrections • Claims remain in RTP file for up to 36 months

• Suppress claims when they aren’t going to be corrected in FISS Limits the number of claims that are viewable in your RTP file

Assists in avoiding duplicate claim submission errors

Medicare Credit Balance Reporting

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Medicare Credit Balance Reporting • Required under the authority of sections 1815(a), 1833(e),

1886(a)(1)(C) and related provisions of the Social Security Act

• Form: CMS-838

• Purpose is to help ensure that monies owed to Medicare are repaid in a timely manner

• Failure to submit within 30 days of the end of the quarter results in payment suspension (due 1/30 4/30, 7/30 and 10/30)

• A credit balance is an improper or excess payment made to a provider as the result of patient billing or claims processing errors

https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/downloads/cms838.pdf

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Medicare Credit Balance Reporting • Need to review a report from your billing system of all

“credit balances”

You can’t just look at total balances by resident because a credit balance could be offset by a debit balance and not show up on a report

• Errors we have seen

One biller said she looked on the FISS system to see if there were any credit balances (which there never were) so she completed the report indicating zero credit balances. She had been doing this for 5+ years!

Several clients only reviewed/reported on Part A credit balances

Not reporting adjusted claims on the report that had been submitted electronically

Not maintaining documentation that shows that each credit balance was reviewed

Therapy Services

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Therapy Occurrence Codes

PT OT SLP

Occurrence Codes/Dates

11 – Onset

symptoms/ illness

29 – Date PT

POC established

or last reviewed

35 – Date PT

began

11 – Onset

symptoms/ illness

17 – Date OT

POC established

or last reviewed

44 – Date OT

began

11 – Onset

symptoms/ illness

30 – Date SLP

POC established

or last reviewed

45 – Date SLP

began

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Therapy Functional Reporting • 42 functional G-codes (14 sets of 3 codes each)

• 6 sets typically reported for PT or OT

Mobility: Walking & Moving Around

Changing & Maintaining Body Position

Carrying, Moving and Handling Objects

Self Care

Other PT/OT Primary

Other PT/OT Subsequent

• 8 sets typically reported for SLP Swallowing

Motor Speech

Spoken Language Comprehension

Spoken Language Expression

Attention

Memory

Voice

Other SLP

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Therapy Functional Reporting • Outset of therapy episode (on the claim for the date of service

of the initial therapy service)

• At least once every 10 treatment days (which correspond with

a newly-revised progress reporting period)

• When an evaluation/re-evaluation is billed (92056, 92597,

92607, 92608, 92610, 926611, 92612, 92614, 92616, 96105,

97001, 97002, 97003 and 97004)

• At discharge

• To end reporting of one functional limitation

• To being reporting of a different functional limitation

Question: Who is responsible and when?

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Therapy Diagnoses • Medical versus Treatment Diagnosis

Medical: Medicare Part A – is the reason for which the resident was hospitalized. Code is taken from hospital discharge paperwork. Will be

the same for each discipline per episode of care.

Medical: Medicare Part B – must be supported in the medical record documentation and relate to the therapy treatment diagnosis. Code is

taken from facility face sheet in the medical record or physician

progress notes if a recent physician visit prompted a therapy referral.

Treatment Diagnoses (all payers) – must be discipline specific and

reflect the patient’s recent impairments that have been assessed and

short and long term goal(s) established to address the impairment(s).

• Medical conditions and/or co-morbidities impacting rehab

should be included on claim

• Code ALL diagnoses that impact rehab

• Sequence the codes in order of amount and complexity of

care provided

Additional Development Request (ADR)

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Additional Development Request • Request for Medical Records

Need to have designated team members to:

• Receive ADR

• Prepare Submission

• Track Decision

• Appeal as needed

45 days to respond (if using FISS printed ADR – records are due 45

days from the date the claim went to S/LOC SB6001)

• In FISS

Main Menu – type 12 for claims

At Claims Inquiry Screen type SB6001 in the S/LOC field and press

Enter

Select the desired claim and press Enter

The ADR letter follows claim page 06 of the claim

The online ADR consists of 2 pages; to view the second page, press

the PF8 key

Be sure to NOT press the PF9 key while viewing a claim in the SB6001

status – this will cause the claim to recycle and generate a second ADR

letter

Triple Check

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Triple Check • Nursing/therapy/medical records/billing compare claim to the

medical record and all supportive documentation

Includes: RUG scores, HIPPS, service dates match ARD, admission

dates, DOS, 3-day qualifying hospital stay, therapy minutes and therapy

days, diagnoses, physician (re)certification, revenue codes, ancillary

services, etc.

• UB04 is a “mini” medical record

• Coded in accordance with coding guidelines for ICD-10 and

must support coverage, medical necessity and services

rendered

UB04 codes should be added to MDS Section 18000 Additional active

diagnoses

Need to coordinate MDS diagnoses with UB04 diagnoses and update

with each submission

Need to coordinate therapy diagnoses with UB04 and update with each

submission

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Triple Check If you don’t conduct a triple check review you may have claims that “look” fine and get paid but that doesn’t mean that they are

accurate and “should” get paid

• Routinely see facilities that do not hold month-end triple check

meetings or conduct triple check reviews

• Routinely see claims with outdated diagnosis codes

Speech therapy services were rendered but there were no related

diagnoses on the claim

Pneumonia for 6+ months

No changes in diagnosis codes after Part A cut

• Much of the review should be completed by the departments

independently prior to the actual meeting

Information Only and No Payment Billing

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Information Only Billing • Beneficiary can choose to enroll in a MAO

• SNFs must submit claim to Medicare after they

receive payment or rejections from MAO plan

Claim needed by Medicare to deduct days (for benefit

period tracking)

Revenue Code 0022 and AAA00 if no assessment was

done

Revenue Code 0120 (R&B)

Condition Code 04 (Medicare MAO responsible)

CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 6, Sections 90 – 90.2

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No Payment Billing IF… THEN…

If you need a denial

notice so another

insurer will pay,

send the initial no-

payment claims

with the “from” date

as the date SNF

care ended. Then

continue to send

claims as often as

monthly

Report: • All days and covered charges as

noncovered, beginning the day

following the day SNF care ended

• Condition Code 21

• Occurrence Span Codes 70 and 74

• Appropriate Patient Status Code

• TOB 210

• HIPPS AAA000

• Submit any Part B services on a

TOB 22X

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No Payment Billing IF… THEN…

If you do NOT need

a denial notice, you

only need to send

one final discharge

claim. The claim

may span both the

SNF and Medicare

Fiscal Year end

dates.

Report: • “From date as the day SNF care ended

• “Through” date as the date of discharge

• All days and charges as non-covered,

beginning the day following the day

SNF care ended

• Condition Code 21

• Occurrence Span Codes 70 and 74

• Appropriate Patient Status Code (not

30)

• TOB 210

• HIPPS AAA00

• Submit any Part B services on a TOB

22X claim

Medicare Beneficiary Identifier (MB)

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New Medicare Beneficiary Identifier (MBI) • Beginning April 2018 – new Medicare cards with new

identification numbers (FL 60) will be mailed

• Transition period – April 1, 2018 thru Dec. 31, 2019

• Beginning April 2018 thru transition period – when submit

HICN on 270 response message will state “CMS mailed a

Medicare card with a new MBI to this beneficiary. Please

get the new MBI from your patient and save it in your

system(s).” The MBI will not be provided in the response.

• Beginning Oct 2018 thru transition period – when submit

claim using HICN, CMS will return both HICN and MBI on

the remit (MBI will be in “changed HICN” field)

Start using MBI as soon as patients get their new cards

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Andrea Hagen, Director Beacon Solutions Group 171 Sully’s Trail Pittsford, NY 14534 Office (585) 662-2270 Cell (585) 967-3716 ahagen@beaconsolutionsgroup.com www.beaconsolutionsgroup.com

CREDIT INSTRUCTIONS

Audio Conference Series: Long Term Care Billing Tips and Best Practices:

• Session 1 - Medicare Hot Topics Date/Time: Sept. 12, 2017, Noon – 12:30 p.m. Credit Available: CPA credit for up to four individuals from the same facility (no affiliates) If you participate in: All 3 sessions: You will receive 1.5 CPEs. 2 of the 3 sessions: You will receive 1 CPE. 1 of the 3 sessions: You will receive 0 CPEs. Instructions for Obtaining Credit: Please complete the evaluation/credit form and fax to FLTC 518.867.8386 or email edu@leadingageny.org by Oct. 10. Print the credit forms for each individual seeking credit. On each form, indicate the name of the person that your organization’s registration is under. Please note: Credit certificates will be issued approximately one month after the last session of the series. Credit Details: LeadingAge New York/FLTC is authorized by the NYS Education

Department to award continuing professional education (CPE) credits to individuals who

successfully complete coursework in the following subject areas: “Accounting, Auditing,

Taxation, Advisory Services and Specialized Knowledge and Applications.”

If you have any questions, please contact Donna Conroy at

518.867.8385, ext. 111 or dconroy@leadingageny.org.

Please fax to FLTC: 518.867.8386 or email edu@leadingageny.org

Evaluation/Credit Form

Audio Conference Series: Long Term Care Billing Tips and Best Practices Audio Conference:

Session 1: Medicare Hot Topics

Date/Time: Sept. 12 - Noon – 12:30 p.m. Credit will be calculated and issued after the last session in the series.

EVALUATION

1. How many other staff from your organization were listening to the audio conference with you? _______________

2. Please check the box that best describes your rating: Excellent Good Fair Poor

a. Overall rating

b. Presenter’s knowledge of material/topic

c. Usefulness of the knowledge/skill required

d. Appropriateness of topic content

Yes No

3. Was participating in this seminar a wise business decision?

If not, why?

_____________________________________________________________________________________________

_____________________________________________________________________________________________

Yes No 4. Is LeadingAge New York/FLTC your first choice for educational opportunities?

5. What new developments in the field do you believe will have an important future impact?

_____________________________________________________________________________________________

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CREDIT INFORMATION - All fields MUST BE COMPLETED below in order for us to process your credit!

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Organization: ____________________________________________________________________________________

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Telephone: ( ) ____________________________E-Mail: ______________________________________________

[ ] CPA CREDIT

LeadingAge New York/FLTC is authorized by the NYS Education Department to award continuing professional education (CPE) credits to individuals who successfully complete coursework in the following subject areas: “Accounting, Auditing, Taxation, Advisory Services and Specialized Knowledge and

Applications.”