Release Newsletter

Version 1.90

JANUARY 2008

Professional Change Summary

We are pleased to announce the release of PC-ACE Pro32 version 1.90. This upgrade contains several CMS Medicare Mandates and product enhancements effective 1/1/2008, including these highlighted changes:

¨ CR5775 – HCPCS Annual Update Reminder – Replaced the HCPCS file with the annual 2008 update applicable to claims with service dates on or after January 1, 2008.

¨ JSM/TDL-08007, 10-01-07 - Mandatory Reporting of the National Provider Identifier (NPI) on all Part A Claims; New Carrier and Part A and Part B Medicare Administrative Contractors (A/B MACs) - Effective March 1, 2008, all Medicare Part B fee-for-service claims must include an NPI in the primary provider fields on the claim (i.e., the billing, pay-to and rendering provider fields).

ENCLOSED Materials

¨ Pre-built PC-ACE Pro32 1.90 upgrade file named PCACEUP.EXE and replacement SETUP.EXE file for any new providers

¨ This Newsletter

CMS Medicare Mandates

CR5775 – HCPCS Annual Update

ª Replaced the HCPCS file with the annual 2008 update for claims processed on or after January 1, 2008. HCPCS Changes: 267 deleted; 755 added; 263 modified. Modifier Changes: 0 deleted; 18 added; 3 modified.

CR5803 – Annual DMEPOS Fee Schedule Update

ª Included in annual HCPCS update (CR 5775)

CR5774 - Medicare Physician Fee Schedule Database (MPFSDB) 2008 File

ª Included in annual HCPCS update (CR 5775)

CR5803 – Annual DMEPOS Fee Schedule Update

ª Included in annual HCPCS update (CR 5775)

CR5774 - Medicare Physician Fee Schedule Database (MPFSDB) 2008 File

ª Included in annual HCPCS update (CR 5775)

CR5728 - Medicare FFS NPI Final Implementation

ª The product is designed to comply with NPI requirements based on flexible "rules" configured by the distributor. No action will typically be required by the users other than entering their NPIs in the Provider (mandatory) and Physician (optional) reference files.

ª Refer to JSM/TDL-08007 for additional NPI implementation dates and reporting requirements.

JSM/TDL-08007, 10-01-07 - Mandatory Reporting of the National Provider Identifier (NPI) on all Part A Claims; New Carrier and Part A and Part B Medicare Administrative Contractors (A/B MACs)

This directive states that effective March 1, 2008, all Medicare Part B fee-for-service claims must include an NPI in the primary provider fields on the claim (i.e., the billing, pay-to and rendering provider fields). You may continue to submit NPI/legacy pairs in these fields or submit only your NPI. The secondary provider fields (i.e., referring, supervising) may continue to include only your legacy number, if you choose. Failure to submit an NPI in the primary provider fields will result in your claim being rejected, beginning March 1, 2008. The following changes have been made in response to this directive (effective 1/1/2008)

ª Fatal Professional claim and provider file edits will require that NPIs be on file for all primary providers referenced on Medicare Part B claims (effective 3/1/2008). The program will continue to report Medicare Legacy IDs in addition to the NPI if they are available.

ª No changes will be made to the NPI requirements for secondary providers. You may continue to submit only Legacy IDs, NPIs and Legacy IDs, or only NPIs as desired. The program will continue to report all identifiers present on the claim.

ª In anticipation of the announced full Stage 3 NPI implementation date (5/23/2008), the product is configured to begin automatically suppressing Legacy IDs in the ANSI-837 output, effective 5/23/2008. Users will not be required to physically remove these Legacy IDs from the claims or the Professional Provider records. This transition to full Stage 3 NPI should be transparent to PC-ACE Pro32 users.

CR5824 - Correct Coding Initiative (CCI) Quarterly Update

ª Installed the January 2008 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

CR5758 - DMC MACs - Discontinuance/Cancellation of the Use of a WL Modifier on Claims for the DeWall Posture Protector Orthortic Jacket HCPCS Code (L0430)

ª Modified an existing Professional claim edit such that modifiers "WL" or KX" are no longer required with the DeWall HCPCS code L0430.

CR5718 - October 2007 Update of the Hospital OPPS: Summary of Payment Policy Changes

ª New HCPCS code effective 10/1/2007:

§ C9236 - INJ, ECULIZUMAB, 10 MG

CR5800 – Remittance Advice Reason Code (RARC) and Claim Adjustment Reason Codes (CARC) Update

ª Updated the Claim Adjustment Reason Codes reference file with the latest WPC published code set. Codes Added: 1; Codes Deleted/Terminated: 5; Codes Modified: 84. The new code is: "212 - Administrative surcharges are not covered". The deleted/terminated codes are: 25, 126, 127, 145 and A4. The modified codes are: 15, 17, 19, 20, 21, 22, 23, 24, 31, 33, 34, 45, 55, 56, 58, 59, 61, 95, 97, 107, 108, 112, 115, 116, 117, 118, 121, 125, 129, 135, 136, 137, 138, 141, 142, 146, 148, 150, 151, 152, 153, 154, 155, 157, 158, 159, 160, 163, 164, 165, 168, 169, 173, 174, 175, 176, 177, 178, 179, 180, 181, 182, 186, 191, 192, 194, 195, 197, 198, 202, 203, 206, 207, 208, A8, B5, B8, B9, B14, B15, B16, B18, B20 and B23.

ª Updated the Remittance Remarks Codes reference file with the latest WPC published code set. Codes Added: 3 ; Codes Deleted: 2 ; Codes Modified: 11. The new codes are: "N430 - Procedure code is inconsistent with the units billed.|Procedure code is inconsistent with the units billed.", "N431 - Service is not covered with this procedure.|Service is not covered with this procedure." and "N432 - Adjustment based on a Recovery Audit.|Adjustment based on a Recovery Audit." The deleted codes are: N14 and N361. The modified codes are: M25, M26, M75, M112, M113, M114, M115, N70, N367, N377 and N385.

CR5777 - Update to Place of Service (POS) Code Set: New Code for Temporary Lodging

ª Added new POS code: 16 - TEMPORARY LODGING (eff: 4/1/2008)

C-Codes HCPCS Update – Source: CMS Website

ª Added new HCPCS codes effective 1/1/2008:

§ C9237 - INJ, LANREOTIDE ACETATE

§ C9240 - INJECTION, IXABEPILONE

§ C9354 - VERITAS COLLAGEN MATRIX, CM2

§ C9355 - NEUROMATRIX NERVE CUFF, CM

Claim Status Response Codes Update – Source: WPC

ª Updated the Claim Status Response Codes reference file with the latest WPC published code set. Codes Added: Category - 0 , Status - 1 ; Codes Deleted: Category - 0 , Status - 0 ; Codes Modified: Category - 0 , Status - 1. The new status code is: "684 - Rejected. Syntax error noted for this claim/service/inquiry." The modified status code is: "145 - Entity's specialty code. This change to be effective 4/1/2008: Entity's specialty/taxonomy code."

Modifications in Support of ANSI (HIPAA) IG Compliance

National Provider Identifier (NPI) – Stage 3 Implementation Update

ª Added the new “NPI Exempt” indicator field to the “Patient Info & General” tab of the Professional claim form. This field specifies whether or not the claim is subject to National Provider Identifier (NPI) reporting requirements. Users may enter a value of “Y” in this field to bypass NPI requirement edits only when appropriate.

ª Per CMS memorandum JSM/TDL-08007 dated 10/1/2007, modified the Professional Claim Import Module to automatically flag Veteran's Administration (VA) claims as exempt from NPI reporting requirements (i.e., sets the claim's "NPI Exempt" field to "Y"). Veteran's Administration claims are Medicare claims which include the Special Project Code value "31" (VA claims). This special project code is reported in the "Demonstration Project Identifier" (REF*P4 ; Loop 2300) segment of the ANSI-837 output file.

PC-ACE Pro32 Report Manager

ª Enhanced the PC-ACE Pro32 Report Manager to add the new preference option “Display the standard print dialog when printing from the report previewer”. This option is disabled by default. Access to the print dialog while previewing a report can be useful if it’s common to print only a subset of the report’s pages. Note: The Report Manager may not be available on all PC-ACE Pro32 installations.

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.