Using Modems for Medicare Connectivity

MEDTranDirect provides connectivity between healthcare providers and all the Medicare contractors (MACs).  Through this connection, providers can have access to the Direct Data Entry (DDE) or FISS system, the ability to send claim files and receive response files like the 835 and 277CA, and connection to the Medicare eligibility system (HETS).

The first two services have been available for almost thirty years.  When they were introduced, access to these systems was achieved through a modem, phone line, and a remote terminal to the IBM mainframe computers running these services.  Now, decades later, this technology is still prevalent among providers who are still using the same methods to access this information and conduct these transactions.  Although many users have replaced the remote terminal with an emulator that can run under Windows on an existing PC, the technology connecting this emulator to the MAC systems still exists and is still supported by many MACs today.

modem blog

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The Impact of CMS Flexibility on ICD10 Implementation

CMS announced a joint statement with the AMA in early July regarding a compromise on how claims with 10 codes would be processed after 10/1/15.  They published FAQs and responses for this announcement on 7/27.

This announcement was advertised to be a settlement between these organizations regarding the efforts of the AMA to delay the implementation of ICD10 and the insistence of CMS that this deadline was final.

Initially, I was concerned about how this announcement might affect the adjudication of all Medicare claims and the potential modifications to Medicare contractor systems we had already tested with our applications over the last several months.  As it turns out, these changes to CMS policy are largely cosmetic and will have no impact on the processing of most claims.  Additionally, although this policy is promoted as a relaxation of the implementation, it provides little relief to healthcare providers and their staff that are unprepared for the transition.

Flexibility
Flexibility

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The Two Faces of CMS IT

As I mentioned in last week’s article, I attended the Healthcare Analytics symposium in Chicago a couple weeks ago.  During this meeting, Niall Brennan, CMS Chief Data Officer, spoke about recent advances and future enhancements to data and systems provided by CMS for the healthcare community.

He described the new “Blue Button Initiative” where CMS and the VA are providing the public access to “synthetic sample data sets for the purpose of fostering innovation and enabling industry stakeholders to provide feedback for future development.”

He discussed the new CMS Virtual Research Data Center (VRDC).  This system allows users to access approved data files within a virtual environment that is supposed to keep this data private and secure.  Users can purchase their own workspace in this environment and upload their own data to generate queries against related CMS information.

Two Faces of CMS IT

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CMS End-To-End ICD10 Testing – April Results

CMS conducted the second round of end-to-end testing of claims with ICD10 data during the third week of April. MEDTranDirect, and one of our customers, Kimble Hospital of Junction, TX, were selected by Novitas for this round of testing.

As part of the testing process, 30 claims were sent for processing through our 837Direct product in a single batch. Most contained ICD10 codes and future dates, some contained ICD9 and current dates. All the submitted claims processed properly and the corresponding 999s and 277CA records were received.

In addition, CMS provided test 835 electronic remittance files that contained payment and adjustment data for the test claims reflecting how they will be paid in October.

ICD10 Testing
ICD10 Testing

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CMS Report Card on ICD10 End-to-End Testing

Medicare held a conference call yesterday (2/26/15) regarding the status of testing between Medicare provider systems, clearinghouses, and the CMS adjudication systems that will be used for processing claims with ICD10 codes in October.

Medicare has been ready for ICD10 for several years. Each quarter, they have updated their systems to prepare for the transition. Early this year, they ran their first live test that involved the processing of test claims submitted by volunteers through the entire adjudication process, including providing remittances.

reportCard

This is referred to by CMS as “end-to-end” testing. This process allows the providers to test their processes including coding with ICD10, the validity of their claim files, and the payments and adjustments returned for the services. It also allows CMS to fine tune their systems to make sure they are ready in October.

There were 661 participating submitters that represented about 1400 NPIs. The tests were performed from 1/26 – 2/3. 14,929 claims were processed and about 81% were accepted. 6% had errors related to ICD9 or ICD10 codes, 13% had other errors not related to ICD10. Of these claims, 56% were professional, 38% institutional and the others suppliers, like DME. Continue reading

Moving from ICD9 to ICD10 – Dealing with the Transition and Learning from the Past

As the healthcare industry prepares for the October transition from ICD9 to ICD10, many organizations are dealing with the obvious issues.  Computer systems are being upgraded to handle the new codes, health plans are developing new business rules for reimbursement, coders and physicians are being retrained.  These are all necessary steps in the adoption of these codes, but some of the most difficult issues will not be in dealing with the new codes, but transitioning to them as these systems are implemented.

One of the strategies in dealing with these types of transitions is to look toward similar situations in the past.  How did this impact you last time?  What issues came up that you did not anticipate?  These transitions are never smooth, but they have to be dealt with.  Experience is the best teacher.

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Florida Medicare – Transitioning Dial-Up Users to a NSV.

first_Coast

First Coast Medicare(FCSO) is terminating dial-up connectivity on March 2, 2015. If you are currently using a dial-up connection to send claims and download remits, it’s time to switch. FCSO has provided a list of their approved Network Service Vendors(NSV) that you can use for these services to prevent any interruption to your cash flow. Continue reading

Looking toward the future – 2015

For any non-seasonal business, the calendar year end is a time to look backward at the year and evaluate your performance and to look forward toward the upcoming year to evaluate your challenges and goals.  At MEDTranDirect, 2014 was a pretty good year as we responded well to industry changes and dramatically expanded our market share in the HIPAA transaction processing business technology sector.

Looking forward to 2015, we have a somewhat unique perspective.  The healthcare industry as a whole is bracing for the impact of ICD-10.  The 10/1/15 deadline will influence the planning for most healthcare business partners including provider organizations, vendors, payers, and government agencies.  This single issue impacts almost every organization that must deal with these codes and their influence on recording diagnoses, procedures and the processing of claims. Continue reading

Preserving Your HIPAA Transaction Files

A few days ago I had a call from a current customer.  They needed help with a project to find claim data that met a certain criteria for additional action.  In this case, a major commercial payer had paid claims late over an extended period of time to healthcare providers all over the country.  This particular hospital had learned at a conference that they could collect the substantial interest on these claims by simply creating a list of the claims that qualified and submitting this list and supporting documentation to the payer.  They had contacted a consultant that was going to assist them with this process.  All they needed was a way to identify these claims and create this list.

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One of our products (835Direct) is capable of loading electronic remittances (835s) into a database and mining the data back out in a variety of formats.  It could have been used to examine the remittance data from this payer and produce a spreadsheet of all claims where the difference in the bill date and the payment date was greater than x. However, the software they use to obtain their remittances imported the remittances into a proprietary product for printing EOBs, posting to AR and such, but did not provide the capability of producing this list.  Furthermore, this vendor does not forward the 835 remittances they receive on behalf of the customer on to the customer.  After they are imported, they are archived by the vendor and the customer must pay service fees to obtain their own information in the original 835 format.  This customer is exploring this option, but even if it is worth the expense, it will take additional time to obtain this information. Continue reading

CMS Creates New Process for Late NOE Appeals

If you are associated with a hospice, you are aware of the new rules regarding the timely filing of NOEs.  You can review these rules in my previous article or through this CMS announcement:

https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3032CP.pdf

cmsnoelateappeals

By now, you have made it through October claim processing and hopefully you experienced as few late NOEs as possible.  If you did have some late NOEs, you might still be able to recover this lost revenue.

In the original announcement, CMS gave the MACs the authority to process appeals for late NOEs and gave the circumstances where these appeals might be granted.  If an appeal is successful, uncovered charges could be reversed by the MACs.

On 11/6, CMS issued another announcement regarding the appeals process for late NOEs:

https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3118CP.pdf

As described in the original announcement, whenever an NOE is filed late (entered in DDE over five days after the admission date), the hospice must report the late NOE on the first claim for the initial hospice benefit period.  This is done by reporting the non-covered days with occurrence span code 77, even if the hospice believes that the NOE is late for reasons eligible for an appeal. Continue reading