Once you have keyed the information on the CWF Part A Eligibility System screen, press. Z – The end of POE indicators for principal and, if applicable other diagnoses. D – Auto no-fault
Option Code. For information about HETS, refer to the CMS website and the Medicare Learning Network (MLN) Matters® article SE1249. For home health outpatient therapy claims (type of bill 34X), enter the referring physician's NPI. Press F1 to see the narrative for the reason code that displays in the lower left corner of the screen. All claims are TOB 32X (CAT code 32) and all were placed in RTP because of clerical errors (CAT code NM). The date the beneficiary was discharged (MMDDYY format). Prior Part B Year – The prior Medicare Part B benefit year. LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR
The accumulated amount by adding the Federal Regional Totals and the Federal National Totals. The description for the adjustment reason code. To check the status of claims, you must first enter your facility's NPI. However, FISS allows the ability for you to retrieve an archived claim to inquire into how it was submitted and processed. The S/LOC field defaults to P. Because you are accessing MAP 1741 from the Claim Cancels option, only claims in a P (Paid) status/location will be displayed. Effective date indicator. The ESRD method of reimbursement effective date. National Coverage Determination Documentation Indicator. The TPX MENU FOR screen will display. 0 – Unchecked (No)
Identifies the line item apportioned amount entered by the provider (if applicable) or apportioned amount calculated by the MSPPAY module of the obligated to accept as payment in full, when value code 44 is present. The specific Hospice Election Period. The intermediary number for the earliest hospital bill processed with a deductible. Identifies the reason for Medicare's decision not to make payment. An Medicare Well Woman Exam, G0101 and Q0091, is not a Routine Preventative Exam, 99387 or 99397, or an Annual Wellness Visit (AWV), G0438. Blood Deductible Pints – The number of blood deductible pints remaining for the benefit period. NOTE: this code displays on home health Requests for Anticipated Payment (RAPs) when: Once you have selected to view a claim from the Claim Summary Inquiry screen (MAP 1741), and press F8 to access Page 02 of the claim, you have the ability to press F11 to move to the right, which will display MAP171E, Press F11 again, and MAP 171A will display, press F11 again, and MAP 171D displays, and press F11 again and Map 171G (home health only) will display. The name associated with the Medicare ID number. National Drug Code (NDC) information. Hospice Terminal Illness Indicator. The reason for this inquiry as entered on the CWF Part A Eligibility System screen. Payment method of the check or electronic funds transfer. You agree to take all necessary steps to ensure that your employees and agents
The accurate information for the nine will disappear and the information for the beneficiary with the blank MID Number field will remain along with the vaccination information at the top of the roster bill screen. The valid values are:
The beneficiary's last name as entered on the CWF Part A Eligibility System screen. Only used from the Claims Correction menu. The occupational therapy cap amount applied in the Part B year. Professional component for this service qualifies for the HPSA bonus payment
CPT codes not covered for indications listed in the CPB: Self-collected / self-sampling HPV tests for screening of cervical cancer - no specific code: 87623: Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), low-risk types (eg, 6, 11, 42, 43, 44) ICD-10 codes covered if selection criteria are met (all-inclusive): labeled "I DO NOT ACCEPT" and exit from this computer screen. If you choose not to correct the claim in RTP, we strongly encourage you to suppress the view of the claim, which will remove the claim from your RTP file sooner. If you have billing experience or have successfully completed medical billing training, this study guide will optimize exam preparation. The study guide is not an introduction to billing but a review of billing concepts. 99 – No iQIES Assessment found. Patient Reimbursement. F11 – Scroll right
Duplicate to a previously submitted claim, Entitled to Medicare Part A, Part B, or both Part A and Part B, Enrolled in a Medicare Advantage (MA) plan, Enrolled with another insurance that is primary over Medicare, In an open 60-day HH PPS (Home Health Prospective Payment System) episode, Met the therapy cap for the calendar year, MBI (Medicare Beneficiary Identifier) Number (also called their Medicare number), If the beneficiary's name is John Smith Jr., enter "SMITHJR", CGS intermediary number (15004 for home health and hospice providers; 15201 for Ohio providers and 15101 for Kentucky providers), To access ELGA and ELGH as you sign into the FISS, type the letters. 3 Certain customized DME items
Screen control. If the other NPI on the claim in not present in the PECOS record, FISS will place a '99' in the 'SC' field. E – pay claim – line full
You may need to contact your connectivity vendor for assistance in mapping your keyboard if your function keys do not achieve the same results as described above. 6 Oxygen and oxygen equipment, Professional Component/Technical Component. Flag 7 – Payment Method Flag
Claim type. Z01.419) will be denied as a provider write-off. H A reply was received from CWF providing a date of death, which required development in order to process the claim (PIP). The default HOST-ID is always GW. For additional information about myCGS, refer to the myCGS User Manual on the CGS website. If the attending NPI on the claim is present in the PECOS record, but the name on the claim does not match the name in the PECOS record, the 'SC' field will be left blank. D Discharge date, Override code. N Medical records were not received and this service received routine manual medical review. ), U5181 (occurrence code 27 required when claim overlaps certification or recertification period). Technical provider liable days. 1 Fee not applicable in Hospital Outpatient Setting
Note: This screen should not be used to determine a beneficiary's status in a home health episode. The following provides information about the ELGA/ELGH eligibility screens. Depending upon the episode information currently available for the beneficiary on this page, you may also need to review the information on ELGA Page 04. If you want to know specifically which six claims are in P B9996, press F3 to exit option 56. Although the claim data is archived, you are able to retrieve an archived claim to inquire into how it was submitted and processed. The CWF Part A Eligibility System screens, ELGA (Part A eligibility information) and ELGH (Home Health/Hospice eligibility information) are accessible through the FISS connection; however, they are not accessible within the FISS menu options. New to this edition Updated listing of all new and changed CPT(r) and HCPCS Level II Modifiers CD-ROM-Contains PowerPoint(r) presentations for each chapter and test-your-knowledge quizzes to aid instructors and self-directed learning New ... Rendering physician's middle initial (not required). These guidelines are a set of rules that have been developed to accompany and complement the official conventions and instructions provided within the ICD-10-CM itself. When there is no actual termination date, the default value of 123119999 will display. The date of the last billable visit in the home health episode. Note: Not all claims that are accessible using this function are appropriate to adjust. Please note that the "TO" date on your HH PPS billing transaction determines the calendar year where the payment was applied and where the claim’s detail information can be accessed. The beneficiary qualified for Part A or Part B Medicare. 3/20/2021. Allowable termination date. This is automatically entered by FISS. liability attributable to or related to any use, non-use, or interpretation of information contained or
Identifies a Medicare beneficiary with a Rep Payee. Suppressed claims (I B9997 status/location) will still appear when viewing claims in option 12 (Claim Summary Inquiry screen). Identifies the Zip Cod 4 digit extension. If you have no remarks to make regarding this claim, you can press. Identifies the occurrence span from date related to the claim. A value equal to R indicates that reconsideration has been performed. R = all units were reduced. To view current check history, type your: National Provider Identifier (NPI) in the, Provider Transaction Access Number (PTAN) in the. 7/20/2021. The valid values are: HCPC – This identifies the HIPPS or HCPCS codes on the 0023 revenue line used for processing/paying the claim. 4 – none of the diagnosis codes on the claim support the medical necessity for the procedure and no additional documentation is provided. Psychiatric Days Remaining – The number of lifetime psychiatric days remaining. The claim suspends and will move to the Return to Provider (RTP) file. The yearly data indicator. The provider number of the hospice who is participating in the Medicare Care Choice Model (MCCM). When left blank, the APP DATE field defaults to the current date. Please make sure that you want to suppress the view of the claim before following the steps below. The date the code became effective (MMDDYY format). Type an "R" to display hospice allowable revenue codes. F5 – Scroll back through a list of claims or revenue code pages
Map numbers (e.g., MAP1701) are listed in the upper left corner of the screen. HCPCS code for the preventive services has been terminated. G – provider liability – full technical – subject to waiver provision
When you have finished reviewing the narrative, press F3 one time to return to the claim. After 36 months, the claim will purge off of FISS. One position numeric field. If the beneficiary has an extensive claim history, you can narrow your search by adding from and to dates. Each type of vaccination must be billed on a separate roster bill. ELGA screen examples and field descriptions are provided later in this chapter. Effective date. The breast cancer risk indicator for the beneficiary. The date the revenue code was no longer valid (MMDDYY format). These may explain why the Health Insurance Prospective Payment System (HIPPS) code submitted on the claim was changed by Medical Review. The third position is optional. Identifies the medical review suspense codes when a claim is edited based on the medical policy parameter file. " " – services did not receive manual medical review
12 = Working Aged
8 – claim was suspended via an OCE MED review reason
To access prior MSP records, type the beneficiary's Medicare Part A or Part B entitlement date in the APP DATE field. Not applicable to home health and hospice claims. The first day of the 60-day Home Health Prospective Payment System (HH PPS) episode. materials including but not limited to CGS fee schedules, general communications, Medicare
Up to five claims can display on Map 1741. Part B Termination Date – The termination date of the current entitlement. The last day of the 60-day HH PPS episode. (This code is applied by FISS based on whether the NPI appears and/or matches an NPI on the Provider Enrollment, Chain, and Ownership System (PECOS).). 2 – Inquiry related to an admission. There are nine host sites as identified in the following table. First Name
The intermediary number of the Medicare contractor that processed the home health billing transaction that established the episode of care. K A definitive response was not received from CWF within 7 days (delayed response) (non-PIP). The "Attachments" options are not accepted electronically via FISS DDE. Shift+Tab– Move from the right to left in valid fields (ex. CMS DISCLAIMER. The beginning date of a beneficiary's election of the MCCM Hospice provider. If you experience any security issues with accessing FISS or need to have your password reset, please email the CGS Security Administration Team at cgs.medicare.opid@cgsadmin.com or you may call them at 1.615.660.5444. The beginning date of service (MMDDYY format), The ending date of service (MMDDYY format). �u�X��n�d�����pA�7�-L�Ă�k1��D5B�
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NR. HCPCS codes for subsequent hospital care services, with the limitation of 1 telehealth visit every 3 days. For hospice claims with dates of service before October 1, 2018, Map 171E was used to enter national drug code (NDC) information when billing non-injectable drugs (revenue code 0250) as required by Change Request 8358. Not applicable to home health and hospice claims. M The MAC has added the code combination and is awaiting approval from CAQH CORE. ANSI End Stage Renal Disease Reduction/Psychiatric Coinsurance/Hemophilia Blood Clotting Factor. 4 Global test only. Medicare Part B Blood Deductible Remaining to be Met – The amount of blood deductible remaining to be met for the prior Part B benefit year. Valid Values:
In the event, the beneficiary is not eligible for the preventive service, the technical and professional date fields will display an abbreviated message that explains why the beneficiary is not eligible. Allowable. Then tab to the S/LOC field and enter P O9998 or R O9998. M The claim was manually set to non-clean. The Reason Codes Inquiry screen (Map 1881) appears: To see the ANSI reason code that corresponds to the FISS reason code press your. Effective Date. The code indicating why payment was not made. The from date for the earliest hospital bill processed with a deductible. The process of the episode (i.e. However, inactive eligibility periods are available by accessing the Eligibility information in the myCGS online web portal. Any use not authorized herein is prohibited, including by way of illustration and not by way of
The Field Guide to Physician Coding, 4th Edition, delivers a payload of precise information on coding rules and relevant billing guidelines. The Geographical Adjustment Factor used to adjust the capital federal rate, based on the applicable wage index. The allowable revenue codes this HCPCS code may use in billing. The ICD-9-CM Code Inquiry screen (Map 1731) appears: To make an additional inquiry, type the new diagnosis code over the previously entered diagnosis code and press. 3 – not paid (status indicators W, Y, or E) or not paid under OPPS (status indicators B, C or Z)
01 – With the use of devised, is able to bathe self in shower or tub independently, including getting in and out of the tub/shower. NOTE: If you are adjusting a rejected claim, your charges have been moved to the noncovered charge field. 2/20/2021. The crossover reference of a Medicare ID number and populates the correct Medicare ID number. Identifies the amount for Return Code from IOCE/OCE. Hospice Only – if documentation for an exception request for an untimely notice of election is not received within 30 days of the initial request, the claim will move to this status/location until day 45, or until your documentation is received. Locations further define what is happening to a billing transaction in a particular status. If, after you press F9, you do not see the message RECORD SUCCESSFULLY ADDED at the bottom of your screen, there is missing or invalid information entered on the roster bill. Enter the paid date shown on the primary payer's remittance advice (MMDDYY format). You may also access this screen by typing 14 in the SC field if you are in an inquiry or claim entry screen. Name of policyholder, last name (then press the Tab key) and first name. The CGS EDI department does not provide support for your connectivity product; therefore, you will need to contact your connectivity vendor for any issues related to your direct connection. This date identifies which Pricer version to obtain data from. The monthly rental charge in dollars for this particular HCPCS code. For information about HETS, refer to the CMS website and the Medicare Learning Network (MLN) Matters® article, SE1249. Valid values are:
Do not bill HCPCS code G0101 in addition to a preventive service reported with CPT® codes 99381â99397. ... 99201-99239, 99241-99255, 99281-99299, G0101, G0175, & G0380-G0384. Do not enter decimal points. The value of '5' identifies services that are subject to the multiple procedure payment reduction (MPPR). The effective date for the alternate reason. This option allows you to view the narrative for the ANSI (American National Standards Institute) codes. An "E" indicates the narrative is for external users. When you search by a beneficiary's Medicare number, you are inquiring about that particular beneficiary; therefore, multiple beneficiaries will not be listed; however, multiple claims may display. Days present on benefit savings record or days reflected in Occurrence Span Code 77 if benefit savings not present. The ADA does not directly or indirectly practice medicine or
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Claims in the RTP file receive a new date of receipt when they are corrected (F9'd) and are subject to the Medicare timely claim filing requirements. Two position numeric field. The number of days used by the beneficiary/patient. You may want to "refresh" your screen to ensure accurate information displays. ELGH displays limited MSP information on screen page 04. (Two most recent home health episodes. To display prior MA plan information, the date entered in the APP DATE field must match the MA enrollment date, termination date, or be within the enrollment and termination date. related listings are included in CDT-4. The following provides instructions on how to: You can use the following function keys to move within the Claim Summary Inquiry screen and within the different claim pages: F3 – Exit (return to the Inquiry Menu)
Only displays if a Record Type 'C' is selected. Valid values: P = partial (if all units except 1 were reduced)
... code (e.g. Identifies the 2-position ANSI group code and 3-position ANSI reason (adjustment) code. All Rights Reserved (or such other date of publication of CPT). When you view claims by status/location code, you will most likely be inquiring about claims in the following status/locations: Claim selected for an additional development request (ADR). Bill CPT code 20610 for this service. Used in the event a Hospital Acquired Condition (HAC) impacts the final MS-DRG assignment. ANSI Remarks Code. To access additional information, type an S in the SEL field. schedules, basic unit, relative values or related listings are included in CPT. Original HCPCS or HIPPS code, or modifiers billed. Referring physician's middle initial (not required). The example below is a home health claim/cancel. Pages 07 and 08 will no longer display after the documentation is received and the claim is moved from status/location S B6001 to S M50MR. 1 – Medicaid
Document Control Number. The date of the issued payment (YYMMDD format). The total PPC payment amount consisting of the Federal, hospital, outlier and indirect teaching portions. The number of hospice days billed to date for a particular beneficiary/patient. If the Medicare number has changed, this field represents the most recent number. ANSI codes (system generated after claim is processed). In some situations, CGS staff may add information in the REMARKS field on Page 04 of the claim to assist you in correcting the claim. These abbreviated messages are: Beneficiary not entitled to Part B or beneficiary's next eligible date is after their Medicare Part B termination date, Beneficiary not eligible due to date of death. "Through" date of service (MMDDYY format). If the APP DATE field is left blank, the most current information will display. Do not use your, If you attempt to type in an invalid field position, your keyboard will lock. Reject Code. Code G0468 must be accompanied by qualifying visit code G0402, G0438 or G0439. Press ENTER. When a claim is submitted using FISS DDE, it processes through a series of edits to ensure the information submitted on the claim is complete and correct. The date the HCPCS code was no longer required for this revenue code (MMDDYY format). CGS encourages you to suppress the view of any billing transaction that you do not intend to correct. Progressive Correction Action. This field is used to select the claim you wish to view. issue with CPT. responsibility for any consequences or liability attributable to or related to any use, non-use, or
I Inpatient/SNF
0 – Unchecked (No)
To avoid billing errors, ensure that the "cancel" claim (XX8 type of bill) is in FISS S/LOC P B9997 prior to submitting a new claim with the corrected information. F10 – Scroll left. In addition to reprinting the PDF of the CMS CoPs and Interpretive Guidelines, we include key Survey and Certification memos that CMS has issued to announced changes to the emergency preparedness final rule, fire and smoke door annual ... If the operating NPI on the claim is not present in the PECOS record, FISS will place a '99' in the 'SC' field. B – ESRD beneficiary in a 30-month coordination period with an employer group health plan
The ADA is a third-party beneficiary to this Agreement. C Code combination is approved
The effective date for the rate listed (MMDDYY format). or on behalf of the CMS. Valid values are:
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