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Elizabeth M. Whitehorn, Director

Provider Notice issued 05/03/16

Chapter H-200, Handbook for Hospital Services

Billing Change for Series Claims Effective June 1, 2016 and Service Line Date (FL 45) Editing

Billing Reminder Regarding Epogen Units and New Edits Effective June 1, 2016

 

To: Participating Hospitals – Chief Executive Officers, Chief Financial Officers, and Patient Accounts Managers; and Renal Dialysis Facilities
Date: May 3, 2016
Re: Chapter H-200, Handbook for Hospital Services
Billing Change for Series Claims Effective June 1, 2016 and Service Line Date (FL 45) Editing
Billing Reminder Regarding Epogen Units and New Edits Effective June 1, 2016

 

Provider Bulletin

 

H-200 16-01

The Department is releasing this bulletin to communicate the following important institutional billing issues. 

  • Billing Change for Series Claims Effective June 1, 2016 and Service Line Date (FL 45) Editing

In an Informational Notice dated February 8, 2013, hospitals and renal dialysis providers were given specific billing instructions in order for the Department to obtain the information necessary to collect rebates on renal dialysis injectable drugs. Federal law requires Medicaid programs to collect rebates on claims for outpatient drugs, including claims billed by non-pharmacy providers.

The Department has reviewed provider compliance with the billing requirements and found a significant number of claims do not contain a Service Line Date (FL 45) associated with the Revenue Lines 0634, 0635, and 0636 for injectable drugs. Per the Handbook for Hospital Services, Appendix H-2C, the Service Line Date is a required field for renal dialysis claims.

Additionally, in order for the Department to verify to the federal government that rebates are being collected properly, the Department must be able to tie a date an injectable drug was given to a specific dialysis treatment date. Therefore, effective June 1, 2016, renal dialysis series claims may no longer be billed with one dialysis revenue line for multiple dates of service. Providers must now identify individual dialysis treatment service lines for each service date.

  • New Claim Edit Relating to Service Line Date - Effective with dates of service on and after June 1, 2016, the Department will reject outpatient renal dialysis claims that do not contain a service line date in FL 45. Providers will receive error code E34 – Missing/Invalid Procedure Date.

 

  • New Claim Edit Relating to Service Line Date – Injectable Drug Revenue Codes

Effective with dates of service on and after June 1, 2016, the Department will reject outpatient renal dialysis claims that do not contain a separate service line for each date of service for Revenue Codes 0634, 0635, and 0636. The service line dates for the injectable drugs must have a corresponding service line date for a dialysis revenue line. Providers will receive error code K42 – Renal Services Invalid as Billed.

As a reminder, providers submitting outpatient institutional claims for renal dialysis injectable drugs are to identify 340B purchased drugs by reporting modifier “UD” in Form Locator 44 of the UB04 or Loop 2400 of the 837I. Modifier “UD” must be the first modifier listed following the procedure code. This policy also applies to Medicare crossover claims.

Hospitals and renal dialysis facilities are required to bill the Department their actual acquisition cost for their 340B drugs, with the exception of drugs on Medicare crossover claims.

  • Billing Reminder Regarding Epogen Units in Value Code (FL 68) and Service Units (FL 46)

Since January 1, 2007, hospitals and renal dialysis facilities have used HCPCS code Q4081 – Injection, Epoetin Alfa 100 units with revenue code 0634 and 0635 when billing for this injectable drug. The associated units based on the procedure code definition must be identified in FL 46. Providers also must identify Value Code 68 in FL 39 with the total units of Epogen given. 

Due to some upcoming Department internal processing changes, it is imperative that providers identify the units correctly in FL 46. This numeric units value, by definition of HCPCS code Q4081, should be 1/100 of the numeric units value identified in FL 39. Incorrect values in FL 46 may cause claim rejections or incorrect payments. 

Example:  Provider identifies Value Code 68 in FL 39 with 84,000 units. FL 46 Epogen units should contain 840 as the units value. 

  • New Claim Edit Relating to Epogen Service Units

Effective with dates of service on and after June 1, 2016, the Department will reject outpatient renal dialysis claims if the sum of all service lines for Revenue Codes 0634 and 0635 with HCPCS code Q4081 multiplied by 100 does not equal the total units for Value Code 68 in FL 39. Providers will receive error code E48 – Invalid Service Units.

  • New Claim Edit Relating to Maximum Units Billable for Epogen

Effective with dates of service on and after June 1, 2016, the Department will reject outpatient renal dialysis claims if the service line units amount for the claim for any Revenue Code 0634 or 0635 with HCPCS code Q4081 exceed the Department’s standard. Providers will receive error code C76 – Maximum Units Exceeded.

The Handbook for Hospital Services billing instructions for renal dialysis claims have been updated and are available on the department’s website. Any questions regarding this bulletin should be directed to a medical assistance consultant in the Bureau of Hospital and Provider Services at
1-877-782-5565.

Instructions for updating the Handbook for Hospital Services:

Appendix H-2C Billing Instructions for Renal Dialysis Claims
Remove pages HFS Appendix H-2c (1-2) (3-4) and insert revised pages HFS Appendix H-2c (1-2)
(3-4).

 

  • Revised pages HFS Appendix H-2c (1-2)  (3-4)