Release Newsletter
Version 2.14
July 2009
Professional
Change Summary
We are pleased to announce the release of PC-ACE Pro32
version 2.14. This upgrade contains
several CMS Medicare Mandates and product enhancements effective 7/1/2009,
including these highlighted changes:
¨ CR6427 – Instructions on Utilizing the 837 Professional CAS Segments for MSP Part B Claims – Edit added to prohibit use of CARC 225
ENCLOSED
Materials
¨ Pre-built PC-ACE Pro32 2.14 upgrade file named PCACEUP.EXE and replacement SETUP.EXE file for any new providers
¨ This
Newsletter
CMS
Medicare Mandates
CR6477 - Addition/Deletion of HCPCS Codes -- Quarterly
Update
ª Added the following
HCPCS codes (effective 7/1/2009):
·
Q4115 - ALLOSKIN SKIN
SUB
·
Q4116 - ALLODERM SKIN
SUB
·
Q2023 - XYNTHA, INJ
ª Added the following
HCPCS modifiers (effective 7/1/2009):
·
PA - SURGERY, WRONG
BODY PART
·
PB - SURGERY, WRONG
PATIENT
·
PC - WRONG SURGERY ON
PATIENT
·
PI - PET TUMOR INIT TX
STRAT
·
PS - PET TUMOR SUBSQ
TX STRATEGY
CR6427 – Instructions
for Utilizing 837 Professional Claim Adjustment (CAS) Segment for MSP Part B
Claims
ª Added a professional claim
edit prohibiting the use of CARC 225 on Medicare claims
ADDITIONAL CMS Mandated CHANGES
CR6413 - April
2009 Integrated Outpatient Editor (I/OCE) Specifications Version 10.1
ª Terminated
HCPCS code "0085T - BREATH TEST HEART REJECT" effective
12/7/2008.
ª Added HCPCS
modifier "K8" effective 4/1/2009
CR6411 -
Implementation of Health Care Claim Status Inquiry and Response (276/277)
Version 005010 - Part B Shared System Change
ª SDI will implement changes to support 5010 requirements over a period of several quarters beginning in the Q2 2009
CR6399 - Implementation of Health Care Claim Status
Inquiry and Response (276/277) Version 005010 - DME Shared Systems
ª SDI will implement changes to support 5010 requirements over a period of several quarters beginning in the Q2 2009
CR6492 - July 2009 Update to the Hospital OPPS
ª Added
the following HCPCS codes (effective 7/1/2009):
·
0199T - PHYSIOLOGIC
TREMOR RECORD
·
0200T - PERQ SACRAL
AUGMT UNILAT INJ
·
0201T - PERQ SACRAL
AUGMT BILAT INJ
·
0202T - POST VERT
ARTHRPLST 1 LUMBAR
ª Numerous
other new HCPCS codes mentioned in this change request have already been added
to the product in a previous release.
CR6484
- July Update to the 2009 Medicare Physician Fee Schedule Database (MPFFSD)
·
Terminated HCPCS Modifier "21 -
PROLONGED E&M SERVICES" effective 12/31/2008
CR6311
– New Physician Specialty Code for Hospice and Palliative Care
ª Added the provider specialty code “17 – Hospice
and Palliative Care” valid for use on or after 10/1/2009
CR6469
– Quarterly Update to CCI Edits, Version 15.2 Effective 7/1/2009
ª Installed the July 2009 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.
CR6431
– Billing Routine Cost of Clinical Trials
ª Added a professional claim edit requiring that diagnosis Code V70.7 be present when HCPCS modifiers 'Q1' or 'QV' are present on Medicare claims with service dates on or after 1/1/2008. This edit is effective 7/10/2009.
July 2009 HCPCS Update (Source: CMS Website)
ª Added the following HCPCS codes (effective
7/1/2009):
·
C9250 - ARTISS FIBRIN
SEALANT
·
C9251 - INJ, C1
ESTERASE INHIBITOR
·
C9252 - INJECTION,
PLERIXAFOR
·
C9253 - INJECTION,
TEMOZOLOMIDE
·
C9360 - SURGIMEND,
NEONATAL
·
C9361 - NEUROMEND
NERVE WRAP
·
C9362 - IMPLNT,BON
VOID FILLER-STRIP
·
C9363 - INTEGRA
MESHED BIL WOUND MAT
·
C9364 - PORCINE
IMPLANT, PERMACOL
ª Modified the descriptions
for the following HCPCS codes:
·
C9358 - SURGIMEND,
FETAL
·
C9359 - IMPLNT,BON
VOID FILLER-PUTTY
Modifications in support of ansi (hipaa) ig compliance
Claim Status Category Code and Claim Status Code Reference
File Update – Source: WPC Published Code Set
ª Updated the
Claim Status Response Codes reference file with the latest WPC published code
set. Codes Added: 2 ; Codes
Deleted/Terminated: 0 ; Codes Modified: 6. The new status codes are: "693
- Amount must be greater than or equal to zero.", "694 - Amount must
not be equal to zero.", "695 - Entity's Country Subdivision
Code." and "696 - Claim Adjustment Group Code." The modified
category codes are: D0, P3 and P4. The modified status codes are: 104, 107 and
402.
C-Codes, April
2009 HCPCS Update (Source: CMS Website)
ª
Added a new HCPCS code effective 4/1/2009:
·
C9249 - INJ,
CERTOLIZUMAB PEGOL
Payer
Identification Number (REF*2U) Support
ª Modified the professional claim module to add
support for the "Payer Identification Number" (REF01 =
"2U") element in the "Payer Secondary Identifier"
(REF/2010B) and "Other Payer Secondary Identifier" (REF/2330B)
segments. This qualifier had been previously omitted because it was assumed
that the payer identification number would always be reported in the NM109
element. Support for the REF*2U segment has been added in response to selected
payers that are requiring a second payer identification number be reported in
this segment.
CORRECTIONS TO CUSTOMER REPORTED PROBLEMS
Modification to the Patient List Report
ª Modified the Patient List report to properly display the primary Payer ID value. The value displayed in the report will now be determined in the following sequence: (a) The Payer ID value specified in the filter criteria, if any; (b) the institutional primary Payer ID, if specified on the patient record, or (c) the professional primary Payer ID value on the patient record.
ANSI-997 Report Utility Modification
ª Modified the ANSI-997 Report Utility to add support for repeating CTX01 elements (10 maximum) in the new ANSI-999 (5010) file format.
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.