SCAN is committed to partnering with our physician providers in offering high quality geriatric care to our members. A significant part of that effort is to assist our providers in the provision of accurate coding that will contribute to the quality of care and support the expected revenue from the Medicare program. To this end, we present the following tools and education for all the physicians and groups providing care to our members.
Wednesday, August 7, 2013
More Full Encounter Data Tips
Issues in Encounter
that Full Encounter Data (FED) submission closely mirrors Fee-for-Service (FFS)
claims submission.Therefore, you should
run reports against encounters submitted under FED that were rejected by CMS:
the Companion Guides help with creating and submitting an EDI transaction,
there are a number of billing guides produced by Medicare Administrative
Contractors that give advice on claim submission.
addition, the cms.gov website also has instructions for claim submissions as
well.Check the Claims Processing Manual
chapter(s) that relates to your type of service.
focus of the guidelines on the CMS website is more on claims submission and
payer processing of claims/encounters for adjudication.Following the instructions on both of these
websites will help you produce encounters which can be processed successfully.
The following websites have billing
information to help you file correctly:
modifier for HCPCS/CPT code (e.g. surgical modifier on an E/M code).
dates of service - Many DMEPOS services require a span of dates of service—for
example, rentals and a month’s worth of supplies.The dates of service should be the 30 day
span that represents the rental or supply period.
that the number of services should reflect the number of days for a rental, or
the number of units for supplies.Do not
default to “1” in these situations.
the correct place of service.The place
of service for DME must be the patient’s home(POS 12). Rarely, a Skilled
Nursing Facility or Nursing Facility is appropriate (POS 31 or 32)
services have specific diagnosis requirements—“CPAP” or “BiPAP” machines require
specific diagnoses. All services except
the few screening services allowed require a specific diagnosis related to the
number of services (e.g., 1 service for 30 day span). Number of services should
be evenly divisible by the date span.
critical information—e.g. ordering provider, rendering provider on a medical
group or DME claim/encounter.
place of service (i.e.Outpatient
service like 99214 billed with Place of service 21, 31 or 32).
or missing origin/destination for ambulance claims.
We hope that this information helps
you in your goal of submitting clean FED claims/encounters.