Follow these tips to comply with PPS
Follow these tips to comply with PPS
The Health Care Financing Administration (HCFA) says the following are some items that providers need to keep in mind to ensure compliance under the outpatient prospective payment system (PPS):
- Hospitals are responsible for proper reporting of units of service. Instructions were issued in Transmittal 747 of the Hospital Manual in December 1999 explaining the proper reporting of units.
- Hospital Manual Transmittal 747 also requires providers to report a line item date of service on every line that requires a HCFA Common
Procedural Coding System (HCPCS) code, even if the dates of service span is the same day (i.e., 08-01-00 to 08-01-00). If the line item date of service is not shown, the claim will be returned to the provider.
- As stated in PM A-00-36, dated June 2000, payment for clinical diagnostic laboratory services furnished under the inpatient Part B benefit (bill type 12X) which were paid on cost prior to PPS, are now paid under PPS. These services must be billed with the appropriate HCPCS code to ensure proper payment.
- When an implantable device such as E0751 or L8600 is billed with revenue code 274, Common Working File (CWF) will reject the claim. Since these devices are no longer subject to payment under the orthotic/prosthetic fee schedule, they should be reported under revenue code 278.
- As stated in PM A-00-45 dated August 2000, there were a number of HCPCS codes that will
be removed from the "inpatient only" list. As a result, these codes have been assigned ambulatory payment classifications (APCs). To avoid rejection of a claim containing any of the codes listed in this PM, hospitals should implement one of two options. You should hold claims containing these codes until Oct. 1, 2000, or submit claims for all services furnished to a beneficiary with the exception of these codes. If the hospital chooses the second option, it must submit an adjustment claim containing all services provided (including any of the codes listed in the PM that were not previously billed) on or after Oct. 1, 2000. In the event a hospital submits a claim containing any of the listed codes prior to Oct. 1, 2000, the claim will be rejected by the Outpatient Code Editor. HCFA will identify and reprocess any claims erroneously rejected because of this issue.
- The Electronic Remittance Advice (ERA) files do contain the APC number assigned at the line, but when files are run through PC Print, the APC number is not printing on the remits. At this time, PC Print is not designed to show this information, and there are no plans at this time to modify PC Print to accommodate this functionality. Providers who need such detail might want to consider moving to an ERA format.
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