Instructions Provided for Medicare Claims-Processing Systems - Brief Article - Statistical Data Included

Healthcare Financial Management, August, 2000

HCFA has issued implementation instructions for the common working file (CWF) and Medicare claims-processing standard systems. In program memorandum AB-00-35, HCFA notes that providers must report line-item dates of service for every line on which an HCPCS code (including modifiers) is required for hospital outpatient, community mental health center, and outpatient partial hospitalization services. Providers also must report units as the number of times the care being reported was performed.

Hospitals whose intermediaries use the Arkansas Part A standard system (APASS) can bill up to 450 revenue lines via direct data entry (DDE) per claim and up to 297 lines via electronic media claim (EMC) per claim. Hospitals whose intermediaries use the fiscal intermediary standard system (FISS) can bill up to 297 revenue lines per claim. (In July, the EMC version 6.0 of the UB-92 was expanded to accommodate 450 revenue input lines, so hospitals whose intermediaries use FISS can then bill up to 450 lines via DDE.)

Billing managers should review the program memorandum to comprehend the numerous changes to the electronic remittance advice (ERA) version 3051.4A. Providers whose intermediaries use FISS and who currently receive the ERA version 3051 .4A should modify their accounting and network systems to accommodate the changes.