PC-ACE Pro32
 

 

 

 

 

 


Release Newsletter

Version 1.88

OCTOBER 2007

Professional Change Summary

 

We are pleased to announce the release of PC-ACE Pro32 version 1.88.  This upgrade contains several CMS Medicare Mandates and product enhancements effective 10/01/2007, including these highlighted changes:

¨ Medicare Contractor Annual Update of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) - ICD-9 Annual Update – 145 new diagnosis codes; 39 new procedure codes

 

ENCLOSED Materials

¨ Pre-built PC-ACE Pro32 1.88 upgrade file named PCACEUP.EXE and replacement SETUP.EXE file for any new providers

¨ This Newsletter

 

CMS Medicare Mandates

CR5454 – Method of Payment for Extended Stay Services Under the Frontier Extended Stay Clinic Demonstration, Authorized by Section 434 of the Medicare Modernization Act

ͺ Added a new HCPCS code "GXXXX - EXTENDED STAY SVCS <= 4 HRS" (effective 10/1/2007).

CR5643 – Medicare Contractor Annual Update of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)

ͺ Integrated the annual ICD-9 diagnosis/procedure code file from CMS into the October 2007 release.  This update includes 145 new diagnosis codes, 39 new procedure codes, 32 modified diagnosis codes, and 64 modified procedure codes.

CR5641 – July Quarterly Update for 2007 DMEPOS Fee

ͺ Modified an existing Professional claim edit which requires modifier KF when reporting Class III devices to remove demoted Ultraviolet Light Therapy System HCPCS codes E0691, E0692, E0693 and E0694. Added non-fatal professional claim edits which prohibit reporting of modifier KF with Class II device HCPCS codes E0691, E0692, E0693 and E0694 (eff 1/1/2005).

CR5563 – Adding CMS Specialty Code for Supplies and/or Oxygen Related Equipment

ͺ Added the following new Specialty Code to the Professional Provider Specialty Codes reference file: "0B1 - Supplier of Oxygen and/or Oxygen Related Equipment". This new code becomes effective for use on 1/1/2008.

CR5703 – Quarterly Update to CCI Edits, Version 13.3, Effective October 1, 2007

ͺ Installed the October 2007 quarterly Correct Coding Initiative (CCI) edit update for Professional claims. The CMS developed the CCI edits to promote national correct coding methodologies and to control improper coding leading to inappropriate payment in Part B claims. The purpose of the CCI edits is to ensure the most comprehensive groups of codes are billed rather than the component parts. Additionally, CCI edits check for mutually exclusive code pairs. Note: PC-ACE Pro32 distributors decide whether or not to activate CCI edits in their builds. As such, these edits may not be available on all PC-ACE Pro32 installations.

 

ADDITIONAL CMS Mandated CHANGES

CR5635 – Revised HCPCS Codes Relating to Immune Globlin

ͺ New HCPCS codes effective 7/1/2007:

§          Q4087 - OCTAGAM INJECTION

§          Q4088 - GAMMAGARD LIQUID INJECTION

§          Q4089 - RHOPHYLAC INJECTION

§          Q4090 - HEPAGAM B INJECTION

§          Q4091 - FLEBOGAMMA INJECTION

§          Q4092 - GAMUNEX INJECTION

ͺ Discontinue HCPCS codes effective 6/30/2007:  J1567

CR5714 – October Update to the 2007 Medicare Physician Fee Schedule Database

ͺ Added a new HCPCS code "G8370 - ASTHMA PT W SURVEY NOT DOCUM" (effective 7/1/2007)

 

Modifications in Support of ANSI (HIPAA) IG Compliance

Category III Codes – Source: AMA Website

ͺ Added the following new HCPCS codes (all effective 1/1/2008):

§          0183T - WOUND ULTRASOUND

§          0184T - EXC RECTAL TUMOR ENDOSCOPIC

§          0185T - COMPTR PROBABILITY ANALYSIS

§          0186T - SUPRACHOROIDAL DRUG DELIVERY

§          0187T - OPHTHALMIC DX IMAGE ANTERIOR

Category I Codes – Source: AMA Website

ͺ Added the following new HCPCS codes (all effective 1/1/2008):

§          90650 - HPV TYP BIVL 3 DOSE IM

§          90661 - FLU VACC CELL CULT PRSV FREE

§          90662 - FLU VACC PRSV FREE INC ANTIG

§          90663 - FLU VACC PANDEMIC

§          90681 - ROTAVIRUS VACC 2 DOSE ORAL

§          90696 - DTAP-IPV VACC 4-6 YR IM

HCPCS Update – Source: CMS Website

ͺ Added the following new HCPCS modifiers (all effective 1/1/2008):

§          EA - ESA, ANEMIA, CHEMO-INDUCED

§          EB - ESA, ANEMIA, RADIO-INDUCED

§          EC - ESA, ANEMIA, NON-CHEM/RADIO

§          ED - HCT>39% OR HGB>13G>=3 CYCLE

§          EE - HCT>39% OR HGB>13<3 CYCLE

Professional Claim Edits

ͺ Added several non-fatal Professional claim edits which require that all secondary provider ID Type (i.e., ANSI qualifier) fields not be left empty when the associated identifier is a valid National Provider ID (NPI). These edits will prevent inadvertent entry of NPIs without the corresponding "XX" type/qualifier code. Secondary providers include Referring, Supervising, Ordering, Purchased Services, and Service Facilities reported at both the claim and line level.

Claim Adjustment Reason Code Update

ͺ Updated the Claim Adjustment Reason Codes reference file with the latest WPC published code set. Codes Added: 7 ; Codes Deleted: 0 ; Codes Modified: 9. The new codes are: "205 - Pharmacy discount card processing fee", "206 - NPI denial - missing", "207 - NPI denial - Invalid format", "208 - NPI denial - not matched", "209 - Per regulatory or other agreement. The provider cannot collect this amount from the patient. ...", " 210 - Payment adjusted because pre-certification/authorization not received in a timely fashion" and " 211 - National Drug Codes (NDC) not eligible for rebate, are not covered.". The modified codes are: 16, 17, 42, 85, 96, 115, 125, 197 and A1.

Claim Status Response Codes Update

ͺ Updated the Claim Status Response Codes reference file with the latest WPC published code set. Codes Added: Category - 0 , Status - 0 ; Codes Deleted: Category - 1 , Status - 20 ; Codes Modified: Category - 0 , Status - 10. The deleted status category codes are: "RQ - General Questions (Yes/No Responses)" (effective 1/1/2008). The deleted status codes are: "8 - No payment due to contract/plan provisions.", "10 - All originally submitted procedure codes have been combined.", "11 - Some originally submitted procedure codes have been combined.", "13 - All originally submitted procedure codes have been modified.", "14 - Some all originally submitted procedure codes have been modified.", "22 - before entering the adjudication system.", "28 - Claim submitted to wrong payer.", "69 - Payment reflects plan provisions.", "70 - Payment reflects contract provisions.", "87 - Denied: Entity not found. (Use code 26 with appropriate Claim Status category Code)", "108 - Coverage has been canceled for this entity. (Use code 27)", "118 - TPO rejected claim/line because payer name is missing. (Use status code 21 and status code 125 with entity code IN)", "119 - TPO rejected claim/line because certification information is missing. (Use status code 21 and status code 252)", "120 - TPO rejected claim/line because claim does not contain enough information. (Use status code 21)", "122 - Missing/invalid data prevents payer from processing claim. (Use CSC Code 21)", "169 - Entity's employer id.", "331 - History and physical. (Use code 316)", "332 - Authorization/certification (include period covered). (Use code 252)", "348 - Chiropractic treatment plan. (Use 345:QL)", and "423 - Prognosis". The modified status codes are: 21, 253, 303, 328, 331, 338, 349, 350, 351, and 585.

Remittance Remark Codes Update – Source: WPC Published Code Set

ͺ Updated the Remittance Remarks Codes reference file with the latest WPC published code set. Codes Added: 42 ; Codes Deleted: 0 ; Codes Modified: 11. The new codes are: N388, N389, N390, N391, N392, N393, N394, N395, N396, N397, N398, N399, N400, N401, N402, N403, N404, N405, N406, N407, N408, N409, N410, N411, N412, N413, N414, N415, N416, N417, N418, N419, N420, N421, N422, N423, N424, N425, N426, N427, N428 and N429. The modified codes are: M26, M27, M70, MA14, MA59, MA62, N12, N84, N85, N125 and N129.

Provider Taxonomy Code Update

ͺ Updated the Provider Taxonomy Code reference file with the latest WPC published code set. Code Added: 23 ; Codes Deleted: 0 ; Codes Modified: 2. The new codes are: "102X00000X - Poetry Therapist", "103GC0700X - Clinical Neuropsychologist : Clinical", "103TE1000X - Psychologist : Educational", "103TM1700X - Psychologist : Men & Masculinity", "103TP2700X - Psychologist : Psychotherapy", "103TW0100X - Psychologist : Women", "172V00000X - Community Health Worker", "1835G0000X - Pharmacist : General Practice", "207QB0002X - Family Medicine : Bariatric Medicine", "207RB0002X - Internal Medicine : Bariatric Medicine", "207RT0003X - Internal Medicine : Transplant Hepatology", "207VB0002X - Obstetrics & Gynecology : Bariatric Medicine", "207ZC0006X - Pathology : Clinical Pathology", "2080T0004X - Pediatrics : Pediatric Transplant Hepatology", "2081N0008X - Physical Medicine & Rehabilitation : Neuromuscular Medicine", "2084B0002X - Psychiatry & Neurology : Bariatric Medicine", "2084N0008X - Psychiatry & Neurology : Neuromuscular Medicine", "213EG0000X - Podiatrist : General Practice", "246ZC0007X - Specialist/Technologist, Other : Certified First Assistant", "252Y00000X - Early Intervention Provider Agency", "273100000X - Epilepsy Unit", "2865C1500X – Military Hospital : Community Health", and "333300000X - Emergency Response System Companies". The modified codes are: "176B00000X - Midwife" and "207XX0004X - Orthopaedic Surgery : Foot and Ankle Surgery".

 

General product enhancements

PC-ACE Pro32 Product Reinstallation Simplification

ͺ Modified the PC-ACE Pro32 installation program (SETUP.EXE) and PC-ACE Pro32 Client installation program (CLIENT32.EXE) to be more tolerant with respect to previous installations. These programs will now check the existing PC-ACE Pro32 entries in the Windows registry to see if they still refer to a valid product installation. If the registry entries appear to be obsolete, the installation programs will silently clear this information from the registry and proceed normally. Previously, the installation programs would abort with an error if remnants of a previous installation were present in the Windows registry. This change will allow simpler reinstallation when the product has been manually uninstalled by deleting the "winpcace" folder tree. These less restrictive rules will also aid installation on Windows Vista computers where the per-user registry settings for administrators and standard Windows users can create confusion.

Miscellaneous ANSI Transaction Handling Improvements

ͺ Implemented changes to simplify the default handling/processing procedures for ANSI-271 (Eligibility/Benefit Response), ANSI-277 (Claim Status Response) and ANSI-835 (Electronic Remittance) files. These improvements significantly reduce the number of steps required to access the information in these files once they have been staged to the appropriate folder. These changes are especially beneficial to sites that use the PC-ACE Pro32 Report Manager to pre-stage files that have been downloaded to a standard "mailbox" folder. It is no longer necessary to manually invoke the Report Manager in order to pre-stage these files. PC-ACE Pro32 will now run the Report Manager automatically in a silent (i.e., hidden) "archive only" mode to perform these pre-staging activities. These enhancements will also aid sites that do not use the Report Manager by eliminating the need to manually open the ANSI-271 or ANSI-277 log screens when the intent is only to process/post a response file already present in the respective staging folder. All such activities are now performed behind the scenes at appropriate points in the standard work flow. For example, launching one of the ANSI-835 Remittance Processors from the "ANSI-835 System Selection" form will now silently invoke the Report Manager to pre-stage files from the standard "mailbox" folder to the appropriate ANSI835 staging folder, when applicable. Simply opening the "Eligibility Benefit Request List" form will now invoke the Report Manager silently to pre-stage files from the standard "mailbox" folder, and then automatically process/post the eligibility responses from any ANSI-271 files present in the predefined staging folder. It is no longer necessary to run the Report Manager manually to pre-stage these files. Neither is it necessary to open the "Eligibility Benefit Response Log" form in order to process/post the ANSI-271 response files. These operations are now performed automatically and transparent to the user. Note that the ANSI-270/271 Eligibility/Benefit Request/Response feature, the ANSI-276/277 Claim Status Request/Response feature, and/or the ANSI-835 Electronic Remittance Processor (ETRA) feature may not be available on all PC-ACE Pro32 installations.

PC-ACE Pro32 Report Manager

ͺ Enhanced the PC-ACE Pro32 Report Manager to perform an automatic cleanup of the standard "mailbox" folder during program startup. All files older than 21 days which aren't recognized by the Report Manager will be deleted from the "mailbox" folder. This maintenance activity will improve performance by preventing a large accumulation of unprocessable files in the mailbox folder. The user may disable this automatic cleanup operation if necessary by unchecking the new "Perform automatic cleanup of old and unprocessable files from standard mailbox folder" preferences option. Note that all users in a networked installation must disable this option in order to prevent the cleanup from occurring. Not all PC-ACE Pro32 installations include the PC-ACE Pro32 Report Manager.

 

Installing the Upgrade

Perform a full PC-ACE Pro32 database backup before installing the upgrade.  To install the upgrade, run the attached PCACEUP.EXE file using Windows Explorer or equivalent, and follow the simple upgrade wizard steps.  When prompted, enter the upgrade password provided by your software supplier.  For networked instructions, it is recommended (but not required) that the update be run from the server’s console.

 

IMPORTANT:  The recommended database backup is for safety purposes only, and should NOT be restored after successfully installing the update.  The update program preserves all existing claims and reference file settings.