Release Newsletter
Version 2.33
January 2012
Institutional
Change Summary
We are pleased to announce the release of PC-ACE Pro32
version 2.33. This upgrade contains several
CMS Medicare Mandates and product enhancements effective 1/1/2012, including
these highlighted changes:
¨ 2012
HCPCS Annual Update Reminder Updated
HCPCS file: 615 added; 272 deleted, and 348 modified.
¨ Update
to Medicare Deductible, Coinsurance and Premium Rates for CY 2012 Updated Institutional claim edits to support
the new 2012 rates
ENCLOSED MATERIALS
· Pre-built PC-ACE Pro32 2.33 upgrade file named PCACEUP.EXE and replacement SETUP.EXE file for any new providers
·
This Newsletter
CMS MEDICARE MANDATES
CR7540 - 2012 Healthcare Common Procedure Coding System (HCPCS) Annual
Update Reminder
ͺ Replaced the HCPCS file with the
annual 2012 update for claims processed on or after January 1, 2012. HCPCS Changes:
615 added; 272 deleted; 348 modified. Modifier Changes: 1 added; 3 deleted; 0 modified.
CR7567 Update to Medicare Deductible, Coinsurance and Premium Rates for 2012
ͺ Added three new
Institutional claim edits to enforce the Medicare
Deductible and Coinsurance amounts for Calendar Year 2012
CR7585
- Claim Status Category and Claim Status Codes Update
Claim
Status Response Codes Reference File Update
ͺ Updated the Claim Status Response Codes reference file with the latest WPC published code set. The code changes described in this change request have already been implemented in a previous release.
CR7530 - Healthcare
Provider Taxonomy Codes (HPTC) Update October 2011
ͺ Updated
the Provider Taxonomy Code reference file with the latest WPC published code
set. The code changes described in this
change request have already been implemented in a previous release.
CR7466 - Medicare Remit
Easy Print (MREP) and PC Print User Guide Update for Implementation of version
5010A1
ͺ
Implemented changes in the Institutional ANSI-835 Remittance Processor to
reflect 5010-related changes made to the PC-PRINT product.
ADDITIONAL CMS MANDATED CHANGES
CR7515 Health Insurance Portability and Accountability Act
(HIPAA) 5010 837 Institutional (837I) Edits and 5010 837 Professional (837P) Edits
- January 2012 Version
Implemented the
following institutional claim and reference file edits to more completely
reflect the version 5010 errata CMS companion guide
ͺ Implemented a fatal institutional claim edit, which
requires a non-zero Units value (SV205/2400) on all service lines
ͺ Modified the Institutional Claim Import Module to
force the service line Units value to "1" when the Units value is
zero in the import file and the claim is likely to be prepared in ANSI Version
5010 format
ͺ Implemented a fatal institutional claim edit
prohibiting reporting of the Subscriber SSN (REF*SY/2010BA) on Medicare (MCA)
claims
ͺ Modified several institutional claim and reference
file edits to prohibit all suggested P. O. Box variations when editing the
Billing Provider ZIP code field. A few additional variations were mentioned in
the CMS companion guide.
ͺ Implemented a fatal institutional claim edit
prohibiting reporting of Payer Secondary Identification (REF/2010BB) qualifiers
"2U" (Payer Identification Number), "EI" (Employer's
Identification Number), "FY" (Claim Office Number), or "NF"
(NAIC Code) on Medicare (MCA) claims
ͺ Added an institutional claim edit which prohibits
reporting of all Service Facility secondary identification numbers (REF/2310E)
on Medicare claims
ͺ Added an institutional claim edit which prohibits
reporting of all claim-level Referring Physician secondary identification
numbers (REF/2310F) on Medicare claims
ͺ Added several institutional claim
edits which prohibit reporting of line-level Operating, Other Operating,
Rendering and Referring Providers unless the associated claim-level providers
are also being reported
ͺ Added institutional claim edits prohibiting the use
of Group Code "CR" (Corrections & Reversals) on version 5010
claims when the associated Adjudication Date is on or after 1/1/2012. This
group code has been eliminated in the Health Care Claim Payment/Advice (ASC
X12N/005010X221 ; Version 5010) implementation guide.
CR7523 - Billing for Donor Post-Kidney Transplant Complication
Services
Made several
institutional claim edit changes to accommodate Medicare billing of Patient
Relationship To Insured code "39" (Organ
Donor). The specific edit changes are:
ͺ Modified an existing institutional claim edit to
permit a Patient Relationship To Insured code of
"39" (Organ Donor) on Medicare claims with service dates on or after
11/28/2011, and transmitted on or after 4/1/2012
ͺ Added an institutional claim edit which requires
Occurrence Code 36 when the Patient Relationship code 39 is present on the claim
(effective 11/28/2011)
ͺ Added institutional claim edits which require
Occurrence Code 36 and Patient Relationship code 39 when HCPCS Modifier Q3 is
present on the claim (effective 11/28/2011)
CR7556 - Discontinuation of Hospice Late Charge
Claims
ͺ Added an institutional claim edit prohibiting
Hospice Late Charge claims (TOB = 815/825) with dates of service on or after
4/1/2012
CR7593 - Clarification and Revisions for Claims
Submitted for End Stage Renal Disease (ESRD) Patients
Made
several institutional claim edit changes to implement new End Stage Renal
Disease (ESRD) claim billing rules. The specific changes are:
ͺ Modified an existing institutional claim edit to
bypass the requirement for reporting the Occurrence Code 51 when the Value Code
D5 is reporting a value of 8.88 for dates of service on or after 1/1/2012
ͺ Added an institutional claim edit which requires
that all 72x type of bills with dates of service on or
after 4/1/2012 report a value code 48 or 49. User is instructed to report a
value of 99.99 if no reading is available
ͺ Added an institutional claim edit which prohibits
reporting an ESA (Q4081 or J0882) with a value of 99.99 in value code 48 or 49
(effective 4/1/2012)
CR7648 - 2012 Annual Update to the Therapy Code List
ͺ Added a new HCPCS code, effective 1/1/2012:
·
92618 - EX FOR
NONSPEECH DEV RX ADD
CR7633 - Screening and Behavioral Counseling
Interventions in Primary Care to Reduce Alcohol Misuse
ͺ Added new HCPCS codes, effective 10/17/2011:
·
G0442 - ANNUAL ALCOHOL
SCREEN 15 MIN
·
G0443 - BRIEF ALCOHOL
MISUSE COUNSEL
CR7635 - CY 2012 Update for Durable Medical
Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee Schedule
ͺ Added new HCPCS codes, effective 1/1/2012:
·
A5056 - 1 PC OST POUCH
W FILTER
·
A5057 - 1 PC OST POU W
BUILT-IN CONV
·
A9272 - DISPOSABLE
MECH WOUND SUCT
·
E0988 -
·
E2358 - GR 34
NONSEALED LEADACID
·
E2359 - GR34 SEALED
LEADACID
·
E2626 - SEO MOBILE ARM
SUP ATT TO WC
·
E2627 - ARM SUPP ATT
TO WC RANCHO TY
·
E2628 - MOBILE ARM
SUPPORTS RECLININ
·
E2629 - FRICTION
DAMPENING ARM SUPP
·
E2630 - MONOSUSPENSION
ARM/HAND SUPP
·
E2631 - ELEVAT
PROXIMAL ARM SUPPORT
·
E2632 - OFFSET/LAT
ROCKER ARM W/ELA
·
E2633 - MOBILE ARM
SUPPORT SUPINATOR
·
L5312 - KNEE DISART,
SACH FT, ENDO
·
L6715 - TERM DEVICE,
MULTI ART DIGIT
·
L6880 - ELEC HAND IND
ART DIGITS
Category II Code
Update (Source: AMA website)
ͺ Added new codes effective 1/1/2012:
·
0555F - SYMPTOM MGMT PLAN
CARE DOCD
·
0556F - PLAN CARE
LIPID CONTROL DOCD
·
0557F - PLAN CAREMNG
ANGNL SYMPTDOCD
·
1010F - SEVERITY
ANGINA BY ACTVTY
·
1011F - ANGINA PRESENT
·
1012F - ANGINA ABSENT
·
1031F - SMOKING + 2ND
HAND ASSESSED
·
1032F - SMOKER/EXPOSED
2ND HND SMOKE
·
1033F - TOBACCO NONSMOKER
NOR 2NDHND
·
1052F - TYPE LOCATION
ACTIVITY ASSES
·
1175F - FUNCTION STAT
ASSESSED RVWD
·
1181F - NEUROPSYCHIA
SYMPTS ASSESSED
·
1182F - NEURPSYCHI
SYMPT 1+PRESENT
·
1183F -
NEUROPSYCHIATRIC SYMP ABSENT
·
1450F - SYMPTOMS
IMPROVED/CONSIST
·
1451F - SYMPT SHOW
CLIN IMPORT DROP
·
1460F - QUAL CARD DIAG
PRIOR 12
·
1461F - NO QUAL CARD
DIAG PRIOR12MON
·
1490F - DEM SEVERITY
CLASSIFED MILD
·
1491F - DEM SEVERITY
CLASSIFIED MOD
·
1493F - DEM SEVERITY
CLASS SEVERE
·
1494F - COGNIT
ASSESSED AND REVIEWED
·
2015F - ASTHMA
IMPAIRMENT ASSESSED
·
2016F - ASTHMA RISK
ASSESSED
·
3019F - LVEF ASSESS
PLANPOST DSCHRGE
·
3055F - LVEF </=
35%
·
3056F - LVEF GREATER
THAN 35%
·
3115F - QUANT RESULTS
ACTIVITY +SYMP
·
3117F - HF ASSESSMENT
TOOL COMPLETED
·
3118F - NY HEART ASSOC
CLASS DOCD
·
3119F - NO EVAL
ACTIVITY CLIN SYMP
·
3517F - HBV
ASSESS&RESULTS INTRP 1YR
·
3520F - CDIFFICILE
TESTING PERFORMED
·
3725F - SCREEN
DEPRESSION PERFORMED
·
3750F -
PTNOTRCVNGSTEROID>/=10MG/DAY
·
4008F - BETA-BLOCKER
THERAPY RXD/TKN
·
4010F - ACE/ARB
THERAPY RXD/TAKEN
·
4013F - STATIN
THERAPY/CURRENTLY TKN
·
4069F - VTE
PROPHYLAXIS RCVD
·
4086F -
ASPIRIN/CLOPIDOGREL RXD
·
4140F - INHALED
CORTICOSTEROIDS RXD
·
4142F - CORTICOSTER
SPARNG TXMNT RXD
·
4144F - ALT LONG-TERM
CNTRL MED RXD
·
4145F - >=2
ANTI-HYPRTNSV AGENTS TKN
·
4322F - CRGVR PROV W/
ED ADDL RSRCS
·
4350F - CNSLNG
PROVIDED SYMP MNGMNT
·
4450F - CNSLNG
PROVIDED SYMP MNGMNT
·
4470F - ICD COUNSELING
PROVIDED
·
4480F - PT RCVNG
ACE/ARB B-BLOCKERTX
·
4481F - PT RCVNG
ACE/ARB BLKER<3MONS
·
4500F - REF TO OUTPT
CARD REHAB PROG
·
4510F - PREV CARDREHAB
QUALCARDEVENT
·
4525F - NEUROPSYCHIA
INTERVEN ORDER
·
4526F - NEUROPSYCHIA
INTERVEN RCVD
·
5250F - ASTHMA
DISCHARGE PLAN PRESNT
·
6101F - SAFETY
COUNSELING PROVIDED
·
6102F - SAFETY
COUNSELING ORDERED
·
6110F - COUNSEL PROV
DRIVING RISKS
·
6150F - PT NOTRCVNG
1ST ANTITNF
Claim Adjustment Reason Code Update (Source
WPC-EDI)
ͺ Updated the Claim Adjustment Reason Codes reference file with the latest WPC published code set. Codes Added: 2 ; Codes Deleted/Terminated: 0 ; Codes Modified: 2. The new codes are: "238 - Claim spans eligible and ineligible periods of coverage, this is the reduction for the ineligible period (use Group Code PR)." and "239 - Claim spans eligible and ineligible periods of coverage. Rebill separate claims (use Group Code OA)." The modified codes are: 18 and 141.
Claim Status
Response Codes Update (Source WPC-EDI)
ͺ Updated the Claim Status Response Codes reference
file with the latest WPC published code set.
Category Codes Added: 0 ; Status Codes
Added: 0 ; Status Codes Deleted/Terminated: 0 ; Status
Codes Modified: 8. The modified status
codes are: 252, 254, 466, 509, 514, 750, 751 and 752.
MODIFICATIONS IN SUPPORT OF ANSI (HIPAA) IG COMPLIANCE
TDL-12015 Addition of New Skilled Nursing Facility
(SNF) Health Insurance Prospective Payment System (HIPPS) Codes to the Fiscal
Intermediary Shared System (FISS), Dated 10/19/2011
ͺ
Modified an institutional claim edit to allow the new HIPPS codes listed in
this change request (effective 10/1/2011)
ͺ
Added a new institutional claim edit which prohibits the use of these new HIPPS
codes prior to 10/1/2011
Updated Present On
Admission (POA) Exemption Listing
ͺUpdated
the ICD-9 reference file to reflect the latest Present On
Admission (POA) exemption listing published on the CMS web site
5010 Errata ANSI Versions Are Defaulted in Submitter
Records
ͺ
Modified the Submitter Information screen such that new records default to the
5010 errata ANSI versions
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 servers 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.