spacehabitats
09-15-2008, 11:27 AM
Just received this in my email today.
Remember, this is just ONE page of a forty page bulletin from the federal government concerning things that I (and ALL doctors) are supposed to understand before we bill Medicare for our services.
And this is just an UPDATE concerning current CHANGES to the monstrosity called Medicare regulations.
If this stuff seems like "gobbledygook" to you, trust me, it seems just as obscure to physicians.
Claim Submission
CLARIFICATION ON THE CORRECT CONDITION CODE TO REPORT
ON PROVIDER ADJUSTMENT REQUESTS TO INDICATE A HEALTH
INSURANCE PROSPECTIVE PAYMENT SYSTEM (HIPPS) CODE
CHANGE
~ Revised CMS MLN Matters ~
MLN Matters Number: MM6002 Revised Related Change Request (CR) #: 6002
Related CR Release Date: July 25, 2008 Effective Date January 1, 2009
Related CR Transmittal #: R1565CP Implementation Date: January 5, 2009
Note: This article was revised on July 28, 2008, to reflect that CR 6002 was revised on
July 25, 2008. The CR release date, transmittal number, and the Web address for
accessing CR 6002 have been changed in this article. All other information remains the
same.
Provider Types Affected
Skilled Nursing Facilities (SNF), Swing Bed (SB) providers, Inpatient Rehabilitation Facilities
(IRF), and Home Health Agencies (HHA) who bill Medicare fiscal intermediaries (FI) and
Medicare Administrative Contractors (A/B MAC) for services provided to Medicare
beneficiaries.
What You Need to Know
CR 6002, from which this article is taken, announces that, as of January 1, 2009, you should
no longer use the D4 condition code to report HIPPS code changes on SNF adjustment
requests, but rather should begin to use Condition Code D2 – Change in Revenue
Codes/HCPCS/HIPPS Rate Codes instead.
Background
Medicare systems have historically required Skilled Nursing Facilities (SNF) and Swing Bed
(SB) providers to append condition code D4 to inpatient adjustment requests when a
change is made to the original Health Insurance Prospective Payment System (HIPPS)
code billed on the claim.
However, because the National Uniform Billing Committee (NUBC) has recently revised the
definition for condition code D4, to indicate a change in clinical codes (ICD) for diagnosis
and/or procedure codes, CR 6002, from which this article is taken, clarifies the correct
condition code to report on adjustment requests when changing a previously processed
HIPPS code.
Effective January 1, 2009, you should no longer use the D4 condition code to report HIPPS
code changes on SNF adjustment requests, but instead should begin to use Condition Code
D2 – Change in Revenue Codes/HCPCS/HIPPS Rate Codes.
In addition, Medicare systems have been updated to require Inpatient IRFs and HH
agencies to also report a condition code D2 on adjustment requests that alter the existing
HIPPS code on a previous paid claim, effective January 1, 2009.
__________________________________________________ ______________________
This bulletin should be shared with all health care practitioners and managerial members of the provider staff.
And they call this a "clarification".....EEEEK!!!!!:eek:
It's so nice to know that I can be held criminally liable if I don't understand all this stuff. :rolleyes:
Remember, this is just ONE page of a forty page bulletin from the federal government concerning things that I (and ALL doctors) are supposed to understand before we bill Medicare for our services.
And this is just an UPDATE concerning current CHANGES to the monstrosity called Medicare regulations.
If this stuff seems like "gobbledygook" to you, trust me, it seems just as obscure to physicians.
Claim Submission
CLARIFICATION ON THE CORRECT CONDITION CODE TO REPORT
ON PROVIDER ADJUSTMENT REQUESTS TO INDICATE A HEALTH
INSURANCE PROSPECTIVE PAYMENT SYSTEM (HIPPS) CODE
CHANGE
~ Revised CMS MLN Matters ~
MLN Matters Number: MM6002 Revised Related Change Request (CR) #: 6002
Related CR Release Date: July 25, 2008 Effective Date January 1, 2009
Related CR Transmittal #: R1565CP Implementation Date: January 5, 2009
Note: This article was revised on July 28, 2008, to reflect that CR 6002 was revised on
July 25, 2008. The CR release date, transmittal number, and the Web address for
accessing CR 6002 have been changed in this article. All other information remains the
same.
Provider Types Affected
Skilled Nursing Facilities (SNF), Swing Bed (SB) providers, Inpatient Rehabilitation Facilities
(IRF), and Home Health Agencies (HHA) who bill Medicare fiscal intermediaries (FI) and
Medicare Administrative Contractors (A/B MAC) for services provided to Medicare
beneficiaries.
What You Need to Know
CR 6002, from which this article is taken, announces that, as of January 1, 2009, you should
no longer use the D4 condition code to report HIPPS code changes on SNF adjustment
requests, but rather should begin to use Condition Code D2 – Change in Revenue
Codes/HCPCS/HIPPS Rate Codes instead.
Background
Medicare systems have historically required Skilled Nursing Facilities (SNF) and Swing Bed
(SB) providers to append condition code D4 to inpatient adjustment requests when a
change is made to the original Health Insurance Prospective Payment System (HIPPS)
code billed on the claim.
However, because the National Uniform Billing Committee (NUBC) has recently revised the
definition for condition code D4, to indicate a change in clinical codes (ICD) for diagnosis
and/or procedure codes, CR 6002, from which this article is taken, clarifies the correct
condition code to report on adjustment requests when changing a previously processed
HIPPS code.
Effective January 1, 2009, you should no longer use the D4 condition code to report HIPPS
code changes on SNF adjustment requests, but instead should begin to use Condition Code
D2 – Change in Revenue Codes/HCPCS/HIPPS Rate Codes.
In addition, Medicare systems have been updated to require Inpatient IRFs and HH
agencies to also report a condition code D2 on adjustment requests that alter the existing
HIPPS code on a previous paid claim, effective January 1, 2009.
__________________________________________________ ______________________
This bulletin should be shared with all health care practitioners and managerial members of the provider staff.
And they call this a "clarification".....EEEEK!!!!!:eek:
It's so nice to know that I can be held criminally liable if I don't understand all this stuff. :rolleyes: