August 2004 Newsletter

U.B. Informed

UB-04

by , EDI Service Specialist, Partner

Did you know that the National Uniform Billing Committee continues to work on the UB-04 and plans to release it next year? It will replace the decade-old UB-92. The changes to the UB-04 involve increasing the number of entries for existing codes and eliminating several data elements that either are not used or can be incorporated into current code structures. The UB-04 is still considered to be in the draft stages and not yet finalized or available. Additional information on the UB-04 is offered to subscribers of the NUBC UB-92 Data Specifications Manual, available on the NUBC web site. Subscribers can get NUBC meeting agendas, minutes and handouts that include regularly updated information about the UB-04.

It was reported in the July 1, 2004 Ohio Hospital Association's Admitting, Billing and Collection (ABC) Bulletin that this committee reviewed the latest draft of the UB-04 and stated it considers the updates to be reasonable and that the new format should not cause much in the way of transitional problems.

Medicare News

Are you aware that there have been several recent changes announced from Medicare? Some of the changes are significant enough that a review is included here. You can check out the entire transmittals on the CMS web site.

Transmittal #188: Use of Code C9399

CMS Transmittal 188 describes billing and payment under the hospital outpatient prospective payment system (OPPS) in calendar year 2004 for new drugs and biologicals after the FDA approval but before assignment of product-specific drug HCPCS codes with an implementation date of July 6, 2004. Beginning January 1, 2004 hospital outpatient department may bill for new drugs and biologicals that are approved on or after January 1, 2004 for which pass-through status has not been approved and a C-code and APC payment have not been assigned.

Hospitals may bill for the drug or biological using a new unclassified code - C9399.

Along with the C-code the National Drug Code (NDC), the quantity of the drug that was administered (expressed in the unit of measure applicable to the drug) and the date the drug was furnished must be reported.

Quadax edits have been modified for the reporting of this information. In Xpeditor -- on the detail line - Place RC 636 in Block 42. Place the word NDC followed by a colon and a space and then the national drug code (ie NDC: 12345678910) in Block 43. Place C9399 in Block 44, Service Date in Block 45 and Units in Block 46.

Note: Contact Quadax's CSC at (866) 422-8079 to ask for an Xpeditor setting to be changed that will allow the entry of the NDC in the description - Block 43.

Transmittal #107: Billing Procedures

A major CMS transmittal (#107) was issued on February 24, 2004 with an effective date of July 1, 2004.

Quadax edits have been modified to include all the changes with this transmittal.

Within this transmittal are many items that are significant to billing. Below are three important ones.

1. For outpatient claims containing RC 045X, 0516 or 0526 - a "Patient Reason for Visit" diagnosis code is required. This is to be reported in Block 76 - Admitting Diagnosis Code.
2. Medicare will consider Bill Types 12X and 22X as Inpatient claims instead of Outpatient claims. This change will result in all inpatient claims including 12X and 22X bill types received on or after July 9, 2004 to be returned to providers if they do not contain the following information:
   • Admission Date
   • Admitting Diagnosis
   • Admission Type Code
   • Patient Status Code
   • Admission Source Code
   This information was not previously required on 12X and 22X bill types.
3. For type of bills 13X, 14X, 22X, 23X, 24X, 32X, 33X, 34X, 71X, 72X, 73X, 74X, 75X, 76X, 81X, 82X, 83X and 85X claims must contain a line item date for each revenue code (detail line) reported.