Hospice MACtoberfest 2018 Direct Data Entry Breakout Session · 2018-11-19 · • Direct Data...
Transcript of Hospice MACtoberfest 2018 Direct Data Entry Breakout Session · 2018-11-19 · • Direct Data...
MACtoberfest®
The information provided in this presentation was current as of September 13, 2018. Any changes or new information superseding the information in this presentation are provided in articles with publication dates after September 13, 2018 posted on our website at: www.PalmettoGBA.com/hhh
Disclaimer
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CPT® only copyright 2017 American Medical Association.
All rights reserved
MACtoberfest®
Direct Data Entry (DDE) and the Notice of Election (NOE)
Presented by: Marilyn Jeske Senior Provider Relations Representative Provider Outreach and Education
• Direct Data Entry (DDE) System Navigating the System
Choosing the Correct Option
• Improvements in Hospice Billing and Claims Processing
• Submitting the Notice of Election (NOE)
• July 2018 Quarterly Systems Release
Agenda
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• The DDE system consists of four (4) main menu options 01 = Inquiries
02 = Claims and Attachments
03 = Claims Corrections
04 = Reports
• Within each main menu option, additional options are available
• Which option is selected will be based on what the user wants to do
• Eligibility records for a beneficiary/patient may also be viewed using the HIQA or HIQH inquiry screen
Navigating Direct Data Entry (DDE)
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DDE Main Menu Screen
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• The Inquiry Menu provides the user the option to view information on a number of items
• The option is selected is dependent upon what the user wants to know Example: Beneficiary’s/patient’s Medicare eligibility = Option
• Once an option is selected, the user must enter certain data to retrieve the desired information
• Section 3 of the DDE User Guide provides all the options that are available under the Inquiry Menu
DDE Inquiry Menu – Option 01
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DDE User Guide, Section 3
DDE Inquiries Menu
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• The Claims/Attachments menu option is selected to submit claims and attachments (if applicable)
• To submit a hospice claim through DDE, select option 28
• To submit a hospice Notice of Election (NOE), Notice of Termination (NOTR), Notice of Change (Transfer), Notice of Change of Ownership, or Notice of Cancelation, select option 49
• Once the desired option is selected, the required data must be entered on each of the six claim page screens
DDE Claims/Attachments Menu – Option 02
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DDE User Guide, Section 4
DDE Claims Entry Menu
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• The claims correction option is used to correct errors on a claim that was Returned to the Provider (RTP), adjust a claim that was finalized and needs to be corrected, or cancel a claim that was submitted in error
• To correct a claim that RTP, select option 29 Claim must be in a T B9997 status and location
• To adjust a finalized claim, select option 35 Claim must be in status and location P B9997 or R B9997
• To cancel a claim, select option 55 Claim must be in status and location P B9997 or R B9997
DDE Claims Correction Menu – Option 03
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DDE User Guide Section 5
DDE Claims Correction Menu
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• The Online Reports menu option is not widely used • The options available are
R1 – Summary of Reports
R2 – View a Report
R3 – Credit Balance Report-Form 838 Inquiry
• Valid reports for option R1 are 050 – Claims Returned to Provider
201 – Pended, Processed and Returned Claims
316 – Errors on Initial Bills
• Option R2 allows you to view any of the reports listed above • Option R3 is rarely used, but can be accessed to view credit/balance
information for claims filed
DDE Online Reports Menu – Option 04
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DDE User Guide Section 6
Reports Menu
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• The Health Insurance Query Access (HIQA) and Health Insurance Query for HHA (HIQH) can be used to view a beneficiary’s/patient’s Medicare eligibility records
• Home health and hospice information can be viewed in either HIQA or HIQH HIQA provides the hospice eligibility information in first several
pages of the record
HIQH provides home health eligibility information in the first several pages of the record
DDE Eligibility – HIQA and HIQH
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DDE User Guide, Section 2
• The NOE must be submitted within 5 days of the date of election
• The NOE can be submitted through the DDE system, via the electronic claims system, or paper (if applicable) Paper NOEs can only be submitted for providers that qualify for
the waiver
Submitting the NOE
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NOE Timely Submission Process
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Patient signs and dates election statement and is
admitted to Medicare hospice benefit
Hospice submits NOE within 5 calendar days of
election date
Medicare systems process NOE according to
data submitted
When all data on NOE is correct, the NOE is
finalized and posted to the Common Working
File (CWF)
Hospice submits subsequent claim(s),
which process and finalize
If patient is discharged or revoked, hospice submits
the NOTR (8xB) or final claim (8X4) within 5 days of discharge/revocation
NOE Late Submission Process
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Patient signs and dates election statement and is
admitted to Medicare hospice benefit
Hospice submits NOE after the 5-day time requirement
Medicare systems process NOE according to data submitted
When all data on NOE is correct, the NOE is finalized and posted to the Common
Working File (CWF)
When applicable, hospice submits subsequent claim(s) to
request an exception
Claim is reviewed to determine if exception is valid; if
exception is valid, claim is processed accordingly; if
exception is not valid, payment is denied for applicable date(s)
Medicare systems will accept any hospice NOE submitted electronically on or after January 1, 2018
• Includes Types of Bill (TOB) 8XA, 8XB, 8XC, 8XD and 8XE
• Companion guide attached to Change Request 10064 provides all the loops and segments that will be required
Submitting the NOE Electronically
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The NOE submitted electronically will be subject to the front-end edits known as the Common Edit Module (CEM) • Providers that choose to submit the NOE electronically should
ensure that they are monitoring their 277CA/999 acceptance reports
• Exceptions to the late submission of the NOE will not be granted for front-end edits that cause the NOE to be late
• Providers should be aware that the NOE submitted electronically may take up to two days from the date of transmission before the NOE is accepted into the claims processing system (Fiscal Intermediary Standard System or FISS) The same holds true for any claim that is submitted electronically
Electronic Submission Notes
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CR 10064, CMS IOM, Publication 100-04, Chapter 11, Section 20.1.1, and NOE Job Aids
Additional fields will be required to submit the NOE (includes 8XA, 8XB, 8XC, 8XD, and 8XE) electronically • Type of Admission (1 – 9) • Admission Source Code (1) • Patient Status Code (30) • Revenue Code (0650) • HCPCS (Q5009) • Service Date (Same as “FROM” date in Statement Covers Field) • Total Units (1) • Total Charges (0.00)
NOE Electronic Submission Data Requirements
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CR 10064, CMS IOM, Publication 100-04, Chapter 11, Section 20.1.1, and NOE Job Aids
MLN Matters® SE18007 • Issued: June 7, 2018 • Subject: Recent and Upcoming Improvements in Hospice
Billing and Claims Processing • Provides information on the updates to Medicare systems
that were implemented with the January 2018 quarterly systems release Submitting the Notices of Election (NOE) via Electronic Data
Interchange (EDI) • Effective January 1, 2018, providers have the option to begin submitting
their NOEs (8XA, 8XB, 8XC, 8XD, and 8XE) via the electronic claims filing system (referenced as EDI) in the article
Improvements in Hospice Billing and Claims Processing
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MLN Matters® SE18007
SE18007
• Hospices no longer have to cancel the NOE (8XA) with an incorrect admission or the NOTR (8XB) with an incorrect discharge/revocation date
• Correction the NOE and Notice of Termination (NOTR) using Occurrence Code 56
• Effective January 1, 2018, providers have the ability to correct the admit date on an NOE or termination date on an NOTR
• Correction process allows the provider to correct the errors rather than cancel the NOE or NOTR
• A corrected NOE or NOTR is submitted with Occurrence Code 56 which reflects the incorrect date admit date submitted on an NOE or discharge date submitted on an NOTR
NOE and NOTR Correction Process
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MLN Matters® SE18007
SE18007
• Condition code D0 (zero) is also submitted on the corrected NOE or NOTR
• If the corrected NOE or NOTR does not include condition code D0 and Occurrence Code 56 and the incorrect date, it will be Returned to the Provider (RTP) for correction
• Correction process applies only to admissions or discharges that occur on or after January 1, 2018
NOE and NOTR Correction Process
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MLN Matters® SE18007
SE18007
• Corrected NOE or NOTR can be submitted electronically, through DDE or hard copy Hard copy may only be submitted by providers that are
authorized to do so
NOE and NOTR Correction
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Initial NOE was submitted with an Admit date of 01/17/XX. The actual Admit date is 01/07/XX. The hospice reports the following to correct the error
NOE Correction Example
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CR 10064, CMS IOM, Publication 100-04, Chapter 11, Section 20.1.1, and NOE Job Aids
NOE Correction Claim Screen
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Initial NOTR was submitted with a “Through” (discharge) date of 01/22/XX. The actual discharge date is 01/21/XX. The hospice reports the following to correct the error
NOTR Correction Example
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CR 10064, CMS IOM, Publication 100-04, Chapter 11, Section 20.1.1, and NOE Job Aids
NOTR Correction Claim Screen
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Changes implemented in the July 2018 quarterly systems release • Redesign of CWF hospice information that has the following
benefits Reduce NOE timely filing exception requests for providers, by ensuring
benefit periods can be cancelled without removing the NOE receipt date
Allow NOTRs to be submitted at any time, rather than only when a benefit period covering the revocation date has been created by claims
Reduce workload for providers when reprocessing periods by automatically removing benefit periods when all claims in the period are cancelled
Enable easier implementation of future policy changes by ensuring data in Medicare systems reflect hospice coverage requirements more clearly
July 2018 Quarterly Systems Release
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MLN Matters® SE18007
SE18007
• Changes also include new election period file and screen Hospices will view the Hospice Election Period screen to
determine the existence of a hospice election
Hospices will view a separate screen for benefit period information
• NOEs will no longer set up the benefit periods Benefit periods will be set up when the first claim is submitted
July 2018 Quarterly Systems Release
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MLN Matters® SE18007
SE18007
Hospice Benefit Period Screen – 1
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Hospice Benefit Period Screen – 2
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Hospice Election Period Screen
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• NOEs for a subsequent election will not post if the current election period is not terminated
• Providers must submit an NOTR or final claim to terminate an existing election in order for a subsequent NOE to process and post
July 2018 Quarterly Systems Release
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MLN Matters® SE18007
SE18007
NOTR (8XB) submission changes require the following: • If no change in the provider number has been made, the
‘From’ date submitted on the NOTR will match the effective election date Date submitted on the NOE (8XA)
• If the revocation/discharge date follows a transfer, the ‘From’ date on the NOTR must match the Start DATE2 on the benefit period that initiated the transfer The ‘From’ date on the 8XC that the receiving hospice submitted
• Admission date on the NOTR must match the ‘From’ date
July 2018 Quarterly Systems Release
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MLN Matters® SE18007
SE18007
With the implementation of the July 2018 Quarterly Systems Release, an NOTR can be submitted even if the discharge/revocation date is outside of the current benefit period posted to the Common Working File (CWF)
July 2018 Quarterly Systems Release
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MLN Matters® SE18007 SE18007
• Patient was admitted to and remained with Hospice A until discharge/revocation
• Hospice A submitted the NOE (81A) with admit date of 03/12/XX
• Patient revoked on 09/01/xx • Hospice A submits the NOTR (81B) within 5 days of the
revocation with the following: Statement ‘FROM’ Date = 03/12/xx Statement ‘THROUGH’ Date = 09/01/xx
Admit Date = 03/12/xx
NOTR: Scenario 1
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Hospice Election Period Screen
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Hospice Benefit Period Screen
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NOTR: Scenario 1 Claim Screen
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• Hospice A admitted the patient on 05/10/xx • Patient transferred to Hospice B on 05/26/xx • Hospice B submits the Notice of Change (81C) with an
admit date of 05/26/xx • Patient is discharged for cause on 07/03/xx • Hospice B (the receiving hospice) submits the NOTR (81B)
as follows: Statement ‘FROM’ Date = 05/26/xx Statement ‘THROUGH’ Date = 07/03/xx
Admit date = 05/26/xx
NOTR: Scenario 2
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Hospice Election Period Screen
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Hospice Benefit Period Screen
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NOTR: Scenario 2 Claim Screen
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Void/Cancel (8XD) submission changes will require the following: • If no change in the provider number has been made, the ‘From’ date on
submitted on the cancelation notice will match the effective election date The date submitted on the NOE (8XA)
• If the cancelation follows a transfer, the ‘From’ date on the cancelation notice must match the Start DATE2 on the benefit period that initiated the transfer Date submitted on the Notice of Change (8XC) submitted by the receiving
hospice
• Admission date on the cancelation notice must match the ‘From’ date • Occurrence code 27 date must match the Admit and ‘From’ date
July 2018 Quarterly Systems Release
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MLN Matters® SE18007
SE18007
• Patient was admitted to and remained with Hospice A until discharge/revocation
• Hospice A submitted the NOE (81A) with admit date of 03/12/XX
• Hospice A has determined that the NOE must be canceled as it was submitted in error
• Hospice A submits the Notice of Cancellation (81D) with the following: Statement ‘FROM’ Date = 03/12/xx
Admit Date = 03/12/xx
Occurrence Code 27 Date = 03/12/xx
Notice of Cancellation: Scenario 1
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Hospice Election Period Screen
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Hospice Benefit Period Screen
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Notice of Cancellation: Scenario 1 Claim Screen
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• Hospice A admitted the patient on 05/10/xx
• Patient transferred to Hospice B on 05/26/xx
• Hospice B needs to cancel the Notice of Change (81C) because Hospice A has not completed their billing
• The receiving hospice submits the Notice of Cancellation (81D) as follows: Statement ‘FROM’ Date = 05/26/xx
Admit date = 05/26/xx
Occurrence Code 27 date = 05/10/xx
Notice of Cancellation: Scenario 2
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Hospice Election Period Screen
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Hospice Benefit Period Screen
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Notice of Cancellation: Scenario 2 Claim Screen
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MACtoberfest®
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