============================================================================= Run Date: FEB 25, 2011 Designation: FB*3.5*115 Package : FB - FEE BASIS Priority: Mandatory Version : 3.5 SEQ #103 Status: Released Compliance Date: MAR 27, 2011 ============================================================================= Associated patches: (v)FB*3.5*111 <<= must be installed BEFORE `FB*3.5*115' (v)IB*2*430 <<= must be installed BEFORE `FB*3.5*115' Subject: UPDATE PLACE OF SERVICE CODES AND ADJUSTMENT REASONS Category: - Routine - Other Description: ============ This patch updates the following: -Place of Service Codes -Adjustment Reason Codes ASSOCIATED REMEDY: ================== 1) HD0000000347537 - PLACE OF SERVICE Code Updates 2) HD0000000196215 - ADJUSTMENT REASON CODES need to be adjusted duplicate(s): HD0000000356262 - Claim Adjustment Reason Code List Changes ASSOCIATED NSR(s): ================== N/A PARTICIPATING TEST SITES: ========================= Chillicothe VA Medical Center James A. Haley Veterans' Hospital - Tampa VA Heartland - West VA Heartland - East REMEDY OVERVIEW: ================ 1) HD0000000347537 - PLACE OF SERVICE Code Updates Problem: -------- The Place of Service codes handled by the Fee Basis software do not account for all codes published by the Centers for Medicaid and Medicare Services. Solution: --------- Routine FBAAFS will be modified to accommodate codes 05, 06, 07, 08, 16, and 17. As of this patch, the Place of Service codes will be classified as follows: Codes considered as facility setting - 05,06,07,08,21,22,23,24,26,31,34,41,42,51,52,53,56,61 Codes considered as non-facility setting - 01,03,04,09,11,12,13,14,15,16,17,20,25,32,33,49,50,54,55,57,60,62,65,71, 72,81,99 2) HD0000000196215 - ADJUSTMENT REASON CODES need to be adjusted Problem: -------- The ADJUSTMENT REASON (#161.91) file needs to be updated. Several new adjustment codes need to be added, some existing codes need to be marked inactive, and others need to be modified. Solution: --------- The ADJUSTMENT REASON (#161.91) file will be brought into compliance by adding and updating the file with all of the codes on the list published at the Washington Publishing Company (WPC). The list of codes (as of this writing) can be found at: http://www.wpc-edi.com/content/view/695/1 Not all codes published by the WPC are relevant to the Fee Basis package, as such, the following changes will specifically affect Fee Basis users. Activations: CODE DESCRIPTION ------------------------------------------------------------------------- 9 The diagnosis is inconsistent with the patient's age. 10 The diagnosis is inconsistent with the patient's gender. 11 The diagnosis is inconsistent with the procedure. 12 The diagnosis is inconsistent with the provider type. 14 The date of birth follows the date of service. 15 The authorization number is missing, invalid, or does not apply to the billed services or provider. 21 This injury/illness is the liability of the no-fault carrier. 23 The impact of prior payer(s) adjudication including payments and/or adjustments. 38 Services not provided or authorized by designated (network/primary care) providers. 60 Charges for outpatient services are not covered when performed within a period of time prior to or after inpatient services. 78 Non-Covered days/Room charge adjustment. 95 Plan procedures not followed. 107 The related or qualifying claim/service was not identified on this claim. 112 Service not furnished directly to the patient and/or not documented. 125 Submission/billing error(s). 133 The disposition of this claim/service is pending further review. 134 Technical fees removed from charges. 150 Payer deems the information submitted does not support this level of service. 151 Payer deems the information submitted does not support this many/frequency of services. 152 Payer deems the information submitted does not support this length of service. 153 Payer deems the information submitted does not support this dosage. 154 Payer deems the information submitted does not support this day's supply. 163 Attachment referenced on the claim was not received. 165 Referral absent or exceeded. 167 This (these) diagnosis(es) is (are) not covered. 170 Payment is denied when performed/billed by this type of provider. 171 Payment is denied when performed/billed by this type of provider in this type of facility. 172 Payment is adjusted when performed/billed by a provider of this specialty 181 Procedure code was invalid on the date of service. 182 Procedure modifier was invalid on the date of service. 188 This product/procedure is only covered when used according to FDA recommendations. 189 'Not otherwise classified' or 'unlisted' procedure code (CPT/HCPCS) was billed when there is a specific procedure code for this procedure/service 199 Revenue code and Procedure code do not match. 203 Discontinued or reduced service. 204 This service/equipment/drug is not covered under the patient's current benefit plan 231 Mutually exclusive procedures cannot be done in the same day/setting. A8 Ungroupable DRG. B22 This payment is adjusted based on the diagnosis. Inactivations: CODE DESCRIPTION ---------------------------------------------------------------------------- 30 Payment adjusted because the patient has not met the required eligibility, spend down, waiting, or residency requirements. 35 Lifetime benefit maximum has been reached. 42 Charges exceed our fee schedule or maximum allowable amount. 47 This (these) diagnosis(es) is (are) not covered, missing, or are invalid. 52 The referring/prescribing/rendering provider is not eligible to refer/prescribe/order/perform the service billed. 57 Payment denied/reduced because the payer deems the information submitted does not support this level of service, this many services, this length of service, this dosage, or this days supply. 59 Charges are adjusted based on multiple surgery rules or concurrent anesthesia rules. 62 Payment denied/reduced for absence of, or exceeded, pre-certification/authorization. 66 Blood Deductible. 85 Patient Interest Adjustment 88 Adjustment amount represents collection against receivable created in prior overpayment. 140 Patient/Insured health identification number and name do not match. 142 Monthly Medicaid patient liability amount. 143 Portion of payment deferred. A2 Contractual adjustment. TECHNICAL: ========== The ADJUSTMENT REASON file (#161.91) is included in this patch. UP SEND DATA USER DATE SEC. COMES SITE RSLV OVER FILE # FILE NAME DD CODE W/FILE DATA PTRS RIDE ------------------------------------------------------------------------------- 161.91 ADJUSTMENT REASON NO NO YES OVER NO NO INSTALLATION INSTRUCTIONS: ========================== This patch may be installed during normal working hours. However, as certain Fee Basis options are going to be placed out of order, it is recommended that Fee Basis users not be on the system at the time. Installation should take under fifteen minutes. 1. Retrieve the KIDS distribution host file. This patch will be distributed in a host file due to the amount of data contained in the patch. The name of the host file is: FEE3_5P115.KID Sites can retrieve VistA software from the following FTP addresses. The preferred method is to FTP the files from: download.vista.med.va.gov This will transmit the files from the first available FTP server. Sites may also elect to retrieve software directly from a specific server as follows: Albany ftp.fo-albany.med.va.gov Hines ftp.fo-hines.med.va.gov Salt Lake City ftp.fo-slc.med.va.gov The FEE3_5P115.KID host file is located in the anonymous.software directory. Use ASCII Mode when downloading the file. 2. Load the KIDS distribution that is contained in file FEE3_5P115.KID using the Load a Distribution option on the Installation menu. 3. Start up the Kernel Installation and Distribution System Menu [XPD MAIN]: Edits and Distribution ... Utilities ... Installation ... Select Kernel Installation & Distribution System Option: Installation 1 Load a Distribution 2 Verify Checksums in Transport Global 3 Print Transport Global 4 Compare Transport Global to Current System 5 Backup a Transport Global 6 Install Package(s) Restart Install of Package(s) Unload a Distribution 4. From this menu, you may elect to use the following options (When prompted for the INSTALL NAME, enter FB*3.5*115): a. Backup a Transport Global - This option will create a backup message of any routines exported with this patch. It will not backup any other changes such as DD's or templates. b. Compare Transport Global to Current System - This option will allow you to view all changes that will be made when this patch is installed. It compares all components of this patch (routines, DD's, templates, etc.). c. Verify Checksums in Transport Global - This option will allow you to ensure the integrity of the routines that are in the transport global. 5. Use the Install Package(s) option and select the package FB*3.5*115. a. When prompted 'Want KIDS to INHIBIT LOGONs during the install? NO//', answer NO. b. When prompted 'Want to DISABLE Scheduled Options and Menu Options and Protocols? YES//', answer YES. When prompted, 'Enter options you wish to mark as 'Out Of Order':', enter: Enter Payment [FBAA ENTER PAYMENT] Multiple Payment Entry [FBAA MULTIPLE PAYMENT ENTRY] C&P/Multiple Patient Payment Entry [FBAA C&P ENTER PAYMENT] Reimbursement Payment Entry [FBAA MEDICAL REIMBURSEMENT] Edit Payment [FBAA EDIT PAYMENT] Ancillary Contract Hosp/CNH Payment [FBCH ANCILLARY PAYMENT] Multiple Ancillary Payments [FBCH MULTIPLE PAYMENTS] Patient Reimbursement for Ancillary [FBCH ANCILLARY REIMBURSEMENT] Services Edit Ancillary Payment [FBCH EDIT ANCILLARY PAYMENT] Calculate Payment Amount [FBAA FEE SCHEDULE RATE] When prompted, 'Enter protocols you wish to mark as 'Out of Order':', enter: Routine Information: ==================== The second line of each of these routines now looks like: ;;3.5;FEE BASIS;**[Patch List]**;JAN 30, 1995;Build 6 The checksums below are new checksums, and can be checked with CHECK1^XTSUMBLD. Routine Name: FBAAFS Before: B27984557 After: B28501893 **4,53,71,92,99,111,115** Routine list of preceding patches: 111 ============================================================================= User Information: Entered By : CHANDARANA,RISHAN Date Entered : MAR 23, 2010 Completed By: DAWSON,TIM Date Completed: FEB 14, 2011 Released By : MURRAY,ANGELA Date Released : FEB 25, 2011 ============================================================================= Packman Mail Message: ===================== No routines included