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

2

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

4

• 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)

5

DDE Main Menu Screen

6

• 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

7

DDE User Guide, Section 3

DDE Inquiries Menu

8

• 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

9

DDE User Guide, Section 4

DDE Claims Entry Menu

10

• 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

11

DDE User Guide Section 5

DDE Claims Correction Menu

12

• 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

13

DDE User Guide Section 6

Reports Menu

14

• 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

15

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

16

NOE Timely Submission Process

17

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

18

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

19

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

20

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

21

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

22

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

23

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

24

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

25

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

26

CR 10064, CMS IOM, Publication 100-04, Chapter 11, Section 20.1.1, and NOE Job Aids

NOE Correction Claim Screen

27

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

28

CR 10064, CMS IOM, Publication 100-04, Chapter 11, Section 20.1.1, and NOE Job Aids

NOTR Correction Claim Screen

29

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

30

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

31

MLN Matters® SE18007

SE18007

Hospice Benefit Period Screen – 1

32

Hospice Benefit Period Screen – 2

33

Hospice Election Period Screen

34

• 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

35

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

36

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

37

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

38

Hospice Election Period Screen

39

Hospice Benefit Period Screen

40

NOTR: Scenario 1 Claim Screen

41

• 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

42

Hospice Election Period Screen

43

Hospice Benefit Period Screen

44

NOTR: Scenario 2 Claim Screen

45

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

46

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

47

Hospice Election Period Screen

48

Hospice Benefit Period Screen

49

Notice of Cancellation: Scenario 1 Claim Screen

50

• 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

51

Hospice Election Period Screen

52

Hospice Benefit Period Screen

53

Notice of Cancellation: Scenario 2 Claim Screen

54

MACtoberfest®

Questions?