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Medicare
No-Pay/Benefits Exhaust Claims Required
Effective October
1, 2006, a SNF is required to submit a bill even though no benefits
may be payable by Medicare. This will allow CMS to keep an accurate
record of all inpatient services for a beneficiary, whether those
services are covered by Medicare or not. These bills are required
in two situations:
-
When
the beneficiary has exhausted their 100 covered days under the
Medicare SNF benefit (referred to as benefits exhaust bills);
and
-
When the beneficiary no longer needs a Medicare covered level
of care (referred to as no-payment bills).
For
details on this new requirement, please refer to the CMS MedLearn
Matters article number MM4292, available on the CMS website at http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM4292.pdf.
ULTRACare
is ready to handle these requirements and will be published as part
of our normal monthly update at our Customer Service Secure Site
on Friday, October 20th. To learn more about how you can use ULTRACare
to accommodate these changes, please download the Technical Bulletin
from our Customer Service Secure Site at https://support.monetteinc.com/documentation/
ULTRACare%20Technical%20Bulletins/.
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The
UB-04 is Coming Soon!
Receivers
(health plans and clearinghouses) will be ready to receive the new
UB-04
by March 1, 2007. Submitters (health care providers such as hospitals,
skilled nursing facilities, hospice, and other institutional claim
filers) can use the UB-04 beginning March 1, 2007, however, they
will have a transitional period between March 1, 2007 and May 22,
2007 where they can use the UB-04 or the UB-92. Starting May 23,
2007 all institutional paper claims must use the UB-04; the UB-92
will no longer be acceptable after this date.
ULTRACare
is being updated to accommodate these requirements. The new UB-04
format has been incorporated as a Crystal Form, much like the UB-92,
and testing is underway. We will notify our customers when all changes
are final and ready for release.
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New ICD-9 Codes Are Available
All customers whose SPSA coverage year started on or after January
1, 2006 have received the updated codes file. If your SPSA year
began before this, you should have received a sales order form that
needs to be approved and returned to us. We can deliver the new
codes file to you very quickly after receiving your order. Effective
with all SPSA renewals in 2006, the ICD-9 code updates are included
at no extra charge.
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National
Provider ID number in ULTRACare?
Yes, ULTRACare
already has a place for the NPI. Your facility's number should
be entered in the Admissions module under the Setup menu option.
From there, choose System Setup, and look for the NPI field…that's
where it belongs. There is also one more field for the facility
NPI number in the Clinical Application module under the Clinical,
Assess, Utilities selection in the
"Edit Electronic Header Record Control Data" option. Look
for the NPI
field and enter the facility's number there. For the doctor's NPI,
enter those on the doctor code setup screen in the NPI field. This
is found in Admissions, Setup, System Codes A-I, Doctor Codes.
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Taxonomy Codes To Be Required January 1,
2007
The
Centers for Medicare & Medicaid Services (CMS) has released
an MLN Matters article regarding requirement that effective January
1, 2007, institutional Medicare providers billing for their primary
facility and its subparts to report a taxonomy code on all of their
claims. You can download the MLN Matters article from the CMS website:
http://www.cms.hhs.gov/MLNMattersArticles/downloads/mm5243.pdf.
.
The taxonomy code will assist Medicare in crosswalking from the
national provider identifier (NPI) of the provider to each of its
subparts in the event that the provider chooses not to apply for
a unique NPI for each of its subparts individually. ULTRACare is
ready to handle these requirements and will be published as part
of our normal monthly update at our Customer Service Secure Site
on Friday, October 20th. There is a new field on the AR System Setup
screen where you fill in your Taxonomy Code.
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