February 2004 Newsletter

U.B. Informed

By: Linda Millheim, EDI Service Specialist, Partner

Hospital Advantage's End Near

It has been reported for some time that Hospital Advantage would soon be retired; March 31, 2004 has now been established as the termination date and notices have been sent to the remaining HA customers.

Hospital Advantage has served the healthcare community well since its introduction in 1992. However, a lot has changed since HA became part of the Quadax family of products and services. Xpeditor, the product introduced in 2000, has quickly become the standard by which other EDI products are judged. HA’s time has come to an end. Effective March 31, Quadax will no longer support Hospital Advantage or accept Hospital Advantage claim submissions.

If you have not yet made the switch to Xpeditor (Enterprise or On-line version), please do not delay any longer. Please call the EDI Client Support Center (866) 422-8079 and ask to speak to Len Stusek.

National Uniform Billing Committee Releases UB-92 Changes

Several UB requirement changes were announced in the November 14, 2003 release by the NUBC. Two of the more significant changes are:

1. The addition of Condition Code 44 – Inpatient Admission Changed to Outpatient. This is to be used on outpatient claims only, when the physician ordered inpatient services, but internal utilization review performed before the claim was originally submitted found that the services did not meet the hospital’s inpatient criteria.
2. The discontinuation of Form Locator (Block) 79 – The indicator that identified the coding method used for procedure coding on the bill is discontinued effective 4/1/2004.
   

National Correct Coding Initiative (NCCI) Edits for Hospitals Outpatient PPS

Quadax is now adjusting Xpeditor UB edits to use the newly-released NCCI edits for Hospital Outpatient PPS, Version 9.3.

As reported in the January 9, 2004 APC Weekly Monitor, CMS has, for the first time posted the specific subset of NCCI edits applicable to OCE on its web site. NCCI for OCE is one quarter behind NCCI for physicians, and does not include a number of edits that would not be applicable to outpatient hospital services, including those for anesthesiology, evaluation & management, mental health, and dermabond. Apart from those broader categories, CMS has selectively removed other edits that may not be appropriate; for example, ‘Q0081/90784-no modifier allowed’ is present in the physician version 9.3 but absent from the OCE version. The good news is, specific information is now available on the CMS web site .

Because of the differences between physician CCI and OCE edits, Quadax has worked with hospital clients to implement custom edits to bypass OCE exclusions. Those bypasses will no longer be needed. Clients for whom custom edits have been programmed should review those to determine if removal of those edits is now warranted. An EDI Support Representative will be happy to help; contact the EDI Client Support Center with questions or to ask for assistance.