Release Newsletter
Version 2.58
Institutional Change Summary
W
e are pleased to announce the release of PC-ACE
Pro32 version 2.58. This upgrade contains
several CMS Medicare Mandates and product
enhancements effective 1/1/2015, including the highlighted
changes:
HOT TOPICS:
·
CR8982 - Update to the Medicare Deductible, Coinsurance, and Premium Rates for CY 2015 - Added three
new Institutional claim edits to enforce the Medicare Deductible
and Coinsurance amounts for Calendar Year 2015
·
CR8975 - HCPCS Annual Update - Integrated the annual
HCPCS and HCPCS Modifiers update from CMS
·
ICD-10 Compliance Readiness Reminder
We encourage all PC-ACE Pro32 users to stay alert for
announcements from your Medicare Administrative Contractor
concerning upcoming ICD-10 testing weeks. Several such
events will be offered as we approach the anticipated October 1,
2015 compliance date. System Designs, Inc. remains committed
to supporting ICD-10 at such time as it is mandated. PC-ACE
Pro32 already includes all core ICD-10 capabilities which can
be enabled when appropriate.
·
Important new information regarding Network Service
Vendor (NSV) connectivity for PC-ACE Pro32 is described on
the System Designs Web site at http://www.systemdesigns.com.
ENCLOSED MATERIALS
·
·
Pre-built PC-ACE Pro32 2.58
upgrade file named
PCACEUP.EXE and replacement SETUP.EXE file for any
new providers
This newsletter
CMS MANDATED CHANGES
CR8982 - Update to the Medicare Deductible, Co-insurance,
and Premium Rates for CY 2015
·
Added three new Institutional claim edits to enforce the
Medicare Deductible and Coinsurance amounts for Calendar
Year 2015
CR8975 - HCPCS Annual Update
Integrated the annual HCPCS and HCPCS Modifiers update
from CMS:
·
HCPCS Changes: 536 added; 396 deleted; 365 modified.
·
Modifier Changes: 7 added; 0 deleted; 0 modified.
See accompanying report for a list of new, deleted and modified
codes.
CR8838 - Implement Operating Rules - Phase III ERA EFT:
CORE 360 Uniform Use of Claim Adjustment Reason Codes
January 2015
(CARC) and Remittance Advice Remark Codes (RARC)
Rule - Update from CAQH CORE
·
Updated the ANSI-835 Remittance Modules (ETRA)
reports to include the October 2014 (Version 3.1.2) release of
the CORE Phase III Claim Adjustment/Denial Business
Scenario code combinations
CR8581 - Automation of the Request for Reopening Claims
Process
Implementation of the new NUBC approved bill type and
condition codes for a request for reopening claims was delayed
from 1/1/2015 to 4/1/2015
·
Modified an existing institutional claim edit such that it
now prohibits transmission of re-opened (Frequency = 'Q')
claims prior to 4/1/2015 instead of the original 1/1/2015
implementation date
CR8874 - Preventive and Screening Services - Update Intensive Behavioral Therapy for Obesity, Screening Digital
Tomosynthesis Mammography, and Anesthesia Associated
with Screening Colonoscopy
Made the following preventive and screening services changes
(effective for service dates on or after 1/1/2015):
·
Added the following HCPCS codes (eff 1/1/2015):
77063 - SCRN BREAST TOMOSYNTH, BILAT
G0473 - FACE BHV CNSL,OBES,2-10,30MN
·
Added an institutional claim edit which requires that
Tomosynthesis HCPCS code 77063 is always billed with
Diagnosis Code V76.11 or V76.12 (ICD-9), or Z12.31 (ICD-10)
·
Added an institutional claim edit which requires that
Tomosynthesis HCPCS code 77063 be billed only on TOBs =
12X, 13X, 22X, 23X, or 85X
·
Added an institutional claim edit which requires that
Tomosynthesis HCPCS code 77063 is billed only with revenue
code 0403, 096X, 097X, or 098X
CR8800 - Additional Functional Changes for Medicare
Claims Processing and Prior Authorization Requests for
Part A, Part B, DME, and Home Health and Hospice
Services
·
Modified several institutional claim edits to accept the
UTN in positions 19-32 of the Prior Authorization field on type
of bill 032x. This change is effective for service dates on or after
1/1/2015. Positions 1-18 continue to hold the OASIS assessment
data.
CR8704 - Change in Applying Co-insurance and Lifetime
Reserve (LTR) Amounts on Informational Only Claims with
Condition Code (CC) 04
·
Modified an existing institutional claim edit which enforces
Medicare inpatient coinsurance rules such that it is now
Continued Page 2 …
January 2015
PC-ACE Pro32
bypassed when Condition Code 04 (Informational Only Claim)
is present on the claim
Claim Adjustment Reason Codes Update (Source: WPCEDI)
·
Updated the Claim Adjustment Reason Codes reference file
with the latest WPC published code set. Codes Added: 7 ; Codes
Deleted/Terminated: 0 ; Codes Modified: 2.
·
The new codes are:
262 - Adjustment for delivery cost. Note: To be used for
pharmaceuticals only
263 - Adjustment for shipping cost. Note: To be used for
pharmaceuticals only
264 - Adjustment for postage cost. Note: To be used for
pharmaceuticals only
265 - Adjustment for administrative cost. Note: To be used for
pharmaceuticals only
266 - Adjustment for compound preparation cost. Note: To be
used for pharmaceuticals only
267 - Claim/service spans multiple months. Rebill as separate
claim/service
268 - The Claim spans two calendar years. Please resubmit one
claim per calendar year
·
The modified codes are: 133 and 201
Remittance Remarks Codes Update (Source – WPC-EDI)
·
Updated the Remittance Remarks Codes reference file with
the latest WPC published code set. Codes Added: 6 ; Codes
Deleted/Terminated: 2 ; Codes Modified: 3.
·
The new codes are:
N729 - Missing patient medical/dental record for this service
N730 - Incomplete/invalid patient medical/dental record for this
service
N731 - Incomplete/Invalid mental health assessment
N732 - Services performed at an unlicensed facility are not
reimbursable
N733 - Regulatory surcharges are paid directly to the state
N734 - The patient is eligible for these medical services only
when unable to work or perform normal ac ...
·
The terminated codes are: N483 and N484 (effective
5/1/2015)
·
The modified codes are: MA09, MA118 and N42
Claim Status Response Codes Update (Source – WPC-EDI)
·
Updated the Claim Status Response Codes reference file
with the latest WPC published code set. Category Codes
Added: 0; Status Codes Added: 2 ; Status Codes
Deleted/Terminated: 0 ; Status Codes Modified: 0.
·
The new Status codes are:
770 - Duplicate of a claim processed or in process as a
crossover/coordination of benefits claim
771 - Claim submitted prematurely. Please resubmit after
crossover/payer to payer COB allotted waiting period
MODIFICATIONS IN SUPPORT OF
ANSI (HIPAA) IG COMPLIANCE
Other HCPCS Codes Update (Source – CMS Website)
·
Added the following HCPCS code (effective 4/1/2015):
Q9975 - FACTOR VIII FC FUSION RECOMB
·
Added the following HCPCS Modifiers (effective
4/1/2015):
EX - EXPATRIATE BENEFICIARY
JF - COMPOUNDED DRUG
Page 2
NUBC Conference Call Minutes (Source – NUBC, 8/21/13)
·
Changed the description of Condition Code 49 to
"REPLACEMENT OF PRODUCT EARLIER THAN
ANTICIPATED LIFECYCLE". This description change is
effective 1/1/2015.
GENERAL
ENHANCEMENTS
PRODUCT
Claim Import and Processing Reports Modified to Include
“Last, First Name” Format
·
Modified the claim import and processing reports to
include the patient's first name. The patient name will now be
presented in the report in "Last, First" format to more
completely identify the patient.
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 server’s 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