FBCS Patch 42 Overview New HCFA Form

1. FBCS Patch 42 OverviewNew HCFA Form

2. Patch 42 Overview • Pre-requisite patches • Background • Primary Purpose • Enhancement Overview • Other Enhancements & Defect Repairs • Questions & Answers • About DSS, Inc.

3. Pre-requisite Patches • Sites must install Patch 41 DSIF*3.2*41 before installing Patch 42

4. Background • In June 2013, the National Uniform Claim Committee approved the Version 02/12 of the 1500 Health Insurance Claim Form • This form includes the addition of an ICD indicator to identify the version of the diagnosis code set being report (i.e., ICD-9 or ICD-10) and expands the number of diagnosis codes that can be reported. *Use of ICD-10 codes should not occur until October 2014

5. Background • Starting January 6 2014, the Centers for Medicare and Medical Services (CMS) will receive paper claims submitted on the revised new HCFA form. • From January 6 to March 2014 both 2/12 and 08/05 versions will be accepted. • From April 1 2014 Medicare will only accept and process the 02/12 version. • With these upcoming changes, FBCS has been modified to accept the new form.

6. Primary Purpose • Fee Basis Claims System (FBCS) Patch 42 primary purpose is to accommodate the revised 2/12 version of the NUCC CMS 1500 form. • Patch 42 will accommodate the new form by enhancing the Optical Character Recognition tool and claim data validation features employed in the Upload and Verify modules.

7. Primary Purpose • Additional changes were made to other FBCS modules to accept the new form fields and provide reporting capabilities. • Patch 42 will also introduce functionality to capture, verify, validate and store the ICD indicator field on a UB04 and validate other fields against this newly captured value.

8. Changes made to the FBCS application Accepting the new hcfa FORM

9. Scanning the New Form • No screen changes have been made to the FBCS Scanning Wizard window. Users will continue to select HCFA-1500 and enter relevant information.

10. Uploading the New HCFA form • No screen changes have been made to the FBCS Upload Wizard. Users will place the new forms on the scanner, select HCFA-1500 form type and enter relevant information.

11. Identifying the New HCFA form • FBCS Upload will read the QR code (located in the upper left corner of the form) via the OCR tool to distinguish the 02/12 form revision. • Once complete, the form will be available for verification in FBCS Verify.

12. Identifying the HCFA Form Version • FBCS Verify will now display the version of the HCFA claim form in the upper middle section of the Verify Screen. • Users can also confirm the version used by viewing the background image displayed in FBCS Verify or selecting the View Claim Form button in Distribution and Processing.

13. Identifying the HCFA Form Version

14. Identifying the HCFA Form Version

15. Identifying the HCFA Form Version • If the system has not identified the correct version of the form, the user will be allowed to change the HCFA version in FBCS Verify.

16. Changing the HCFA Form Type • To change the HCFA form version in FBCS Verify, select the Edit Menu. Select Change Status and then Change HCFA version. • The user will not be able to select the current form.

17. Manually Creating a HCFA with the new format • Per current functionality, the user can manually create a claim form via Edit menu. • FBCS Verify will now give the user the option to choose the version of the HCFA form to be created; HCFA 0805 or HCFA 0212.

18. Verification and Capture of Form Fields CMS 1500 HCFA 2/12 FORM

19. Fields Captured on the New HCFA form • FBCS Verify will capture and validate new fields on the New HCFA form: • Original Reference Number • Prior Authorization Number • ICD Indicator • Diagnosis codes A-L • FBCS will continue to capture and validate existing fields that are unchanged • FBCS will no longer require Balance Due

20. Original Reference Number • FBCS Verify will now capture and enforce the following business rules for the Original Ref. No. field (Box 22): • Only alphanumeric characters, hyphens, single spaces and decimals allowed • Only up to 18 characters in length · • The first character must be alpha or numeric

21. Prior Authorization Number • FBCS Verify will now capture and enforce the following business rules for the Prior Authorization Number field (box 23): • Maximum of 29 alphanumeric characters • Accepts hyphens, single spaces and decimals • The first character must be alpha or numeric

22. ICD Indicator • FBCS will capture the ICD Indicator field and accept a value of 9 or 0. The field is located in the upper right corner of Box 21. • Users will receive a prompt if the ICD Indicator field value is invalid.

23. Diagnosis Code fields A through L • FBCS will capture diagnosis code fields A through L (Box 21) • Diagnosis codes will be validated based on the ICD Indicator field.

24. Diagnosis Code field Validation • If the indicator has a value of 9: • The 12 diagnosis code fields (A-L) will be accepted if they comply with the following ICD-9 code criteria: • 3-5 characters in length • Decimals are allowed (between positions 3 and 4) • First digit may alpha (E or V) OR numeric (2-5) • Second through fifth digits are numeric

25. Diagnosis Code field Validation • If the indicator has a value of 0: • The 12 diagnosis fields (A-L) will be accepted if they comply with the following ICD-10 code criteria: • 3-7 characters in length • Decimals are allowed (between positions 3 and 4) • First digit is a letter of the alphabet • Second and third digits are numeric • Fourth through seventh digits are alphanumeric .

26. ICD Indicator & Diagnosis field validation • Users will receive a prompt if the Diagnosis codes do not comply with the ICD Indicator.

27. Diagnosis Pointer Field Validation • FBCS will validate the diagnosis pointer field (Box 24E) for the following conditions: • Alpha characters between (A – L), or numbers representing diagnosis codes (1-12) based on the values in Box 21 • Max of 4 characters or 4 diagnosis codes • No Null values • No symbols • The field will be validated for each line of the claim form.

28. Diagnosis Pointer field • The field is located to the right in Box 24.

29. Balance Due field Changes • FBCS Verify will not capture or require the Balance Due field (Originally Box 30) to be verified on the new HCFA form. This field has been renamed “Rsvd for NUCC Use” • Balance Due will continue to be captured for the HCFA form 08/05

30. Verification and Capture of Form Fields UB04 FORM

31. UB-04 ICD Indicator field • FBCS will now capture and verify the new ICD indicator field (Box 66) based on the following business rules: • FBCS will only accepted values of 0 or 9. A value of 0 indicates codes with the ICD10 format. A value of 9 indicates codes with the ICD9 format. • No alphabetic characters, symbols, or null values will be accepted.

32. Procedure Code Validation • FBCS will validate all Procedure codes (Box 74 and 74A through E) based on the ICD Indicator.

33. Procedure Code Validation • If the ICD indicator has a value of 0 all procedure codes will be accepted if they comply with the following criteria: • 3 Alpha Numeric only, no special characters such as decimals. • Length must be seven characters • First character may be 0-9 or any letter of alphabet except ‘O’ or ‘I’ • Letters ‘O’ or ‘I’ are not allowed in any position • The user will be prompted to enter the correct value when applicable.

34. Procedure Code Validation • If the ICD indicator has a value of 9 all procedure codes will be accepted if they comply with the following criteria: • Numeric only • Must be 3 or up to 4 digits with a decimal after the second digit • The user will be prompted to enter the correct value when applicable.

35. Diagnosis Code Validation • FBCS will validate all Diagnosis codes (Box 67 and 67A through Q) based on the ICD Indicator.

36. Diagnosis Code Validation • If the ICD indicator has a value of 0all diagnosis codes will be accepted if they comply with the following criteria: • 3-7 characters in length • Digit 1 is alpha; digits 2 and 3 are numeric; digits 4-7 are alpha or numeric • The user will be prompted to enter the correct value if applicable

37. Diagnosis Code Validation • If the ICD indicator has a value of 9 all diagnosis codes will be accepted if they comply with the following criteria: • 3-5 characters in length • First digit may be alpha (E or V) or numeric; digits 2-5 are numeric • The user will be prompted to enter the correct value.

38. Updates to FBCS Admin, FBCS Verify, FBCS Payment, FBCS Authorization and FBCS D&P Modules Other enhancements & defect repairs

39. FBCS Admin New Reportable Fields • HCFA Category • Original Ref Number • Prior Authorization Number • ICD Indicator • Diagnosis codes A-L (existing) • UB Category • ICD Indicator • Combined Claims • ICD Indicator

40. Reportable field – ICD Indicator • Claims that have been verified before Patch 42 installation will print on reports with the ICD Indicator value of Unspecified.

41. Reportable field ICD Indicator – Criteria Selection • When selecting criteria of ICD9 for the ICD Indicator, FBCS will display a value of 9 on the Criteria window.

42. Reportable field ICD Indicator – Criteria Selection • When selecting criteria of ICD10 for the ICD Indicator, FBCS will display a value of 0 on the Criteria window.

43. Reportable field ICD Indicator – Criteria Selection • When selecting criteria for the ICD Indicator that is neither ICD9 or ICD10, FBCS will display a value of 99 on the Criteria window.

44. FBCS Verify • Validation has been added to the HCFA Units field (Box 24G). The user will be prompted if the value entered is not between 0 and 99999. • FBCS will no longer prompt for verification minutes for the following CPT codes: • 01996 01953 01968 01969 and 01990  • FBCS will now stop on all line item charges.

45. FBCS Payment • Fixed an issue on the PIT Review queue that displayed the CPT code in the Modifier column when there were no Modifiers for the specified CPT code. • When payments are made, FBCS will retrieve the Primary Service Area of the linked authorization. • Corrected Claim Inspector disposition rules to exclude claims with status other than In Payment for possible re-disposition.

46. FBCS Authorization • The main window title now correctly displays the site name for integrated sites.

47. FBCS Distribution & Processing • Changed the wording on the display message for the timely filing popup to read: "The new effective date that you have chosen, mm/dd/yyyy, is x days from the scanned/reopened date." • FBCS duplicate logic has been changed to identify claims with or without a space between the CPT code and modifier.

48. Items to Note • Any HCFA 2/12 claims received prior to Patch 42 install cannot be successfully read and/or all data cannot be successfully captured by FBCS.

49. Questions & Answers

50. About Document Storage Systems, Inc. (DSS) • DSS is a leading health information technology (HIT) software development and systems integration company based in Juno Beach, Florida, with over 375 employees. • We empower health systems and hospitals to enhance patient care by adopting VistA-based EHR solutions that enable interoperability, improve healthcare quality, enhance revenue cycles and reduce cost. • For more than 20 years, healthcare organizations have benefited from our technical and service integration expertise with the Veterans Health Information Systems and Technology Architecture (VistA) – a fully integrated Electronic Health Record (EHR). • DSS released, vxVistA, which takes the most reliable and widely used open source EHR in the country to a new level to meet the needs of hospitals, clinics, long-term care facilities and physician practices. • Active member and supporter of the Open Source Electronic Health Record Agent (OSEHRA) organization as well as founder and supporter of www.ThevxVistA.org, a forum for discussion and best practices among worldwide vxVistA and VistA EHR users. • For more information, please visit www.dssinc.com