Setup and Billing for Negative Pressure Wound Therapy (CR9736)

Transcription

1 Setup and Billing for Negative Pressure Wound Therapy (CR9736) As of 1/1/2017, Medicare Home Health visits where the sole purpose is for Negative Pressure Wound Therapy (NPWT) using a disposable device should be billed separately from the PPS claim as outpatient and are reimbursed separately the Outpatient Prospective Payment System (OPPS) amount. If disposable NPWT is performed as part of an otherwise covered Home Health visit, the portion of time spent on dnpwt should not be included on the Home Health PPS claim. The dnpwt visit, or portion thereof, is billed on a separate claim using type of bill 034x with revenue code 0559 (SN), 042X (PT), or 043X (OT), along with the appropriate HCPCS code or If preferred, NPWT can also be billed directly via DDE. TABLE OF CONTENTS One-Time Setup... 1 Create NPWT Revenue/HCPCS Combinations... 1 Create NPWT Charge Codes... 2 Create A Part B Financial Class... 3 Insurance Setup... 4 Create a NPWT Option Set... 5 NPWT Billing Process... 5 Add Medicare Part B to Patient File... 5 Enter the NPWT Visit... 6 Billing & Claims... 6 ONE-TIME SETUP CREATE NPWT REVENUE/HCPCS COMBINATIONS Go to File>File Maintenance>Category. Click Change Type and set to Revenue Code. 716 Newman Springs Road Lincroft, NJ Tel Page 1 of 6

2 Press the Add button to add a new code combination. Enter the data in the corresponding fields as listed in Table 1. Repeat this step for each code combination needed. Table 1: Code Description CPT/HCPCS Other Code SN NPWT < 50 sq cm SN NPWT > 50 sq cm PT NPWT < 50 sq cm PT NPWT > 50 sq cm OT NPWT < 50 sq cm OT NPWT > 50 sq cm CREATE NPWT CHARGE CODES Go to File > File Maintenance > Charge Code. Note: clinical system users should also add these codes in their clinical software and make sure the codes and descriptions match. Press the Add button to add new charge codes. Enter the data in the corresponding fields as listed in Table 2. Repeat this step for each code needed. Table 2: Charge Code Description Modality Start Date Basis Gross Net Rev Code SNNPWT SN NPWT < 50 sq cm Skilled Nursing 1/1/2017 Visit * * SNNPWT50 SN NPWT > 50 sq cm Skilled Nursing 1/1/2017 Visit * * PTNPWT PT NPWT < 50 sq cm Physical Therapy 1/1/2017 Visit * * Newman Springs Road Lincroft, NJ Tel Page 2 of 6

3 PTNPWT50 PT NPWT > 50sq cm Physical Therapy 1/1/2017 Visit * * OTNPWT OT NPWT < 50 sq cm Occupational Therapy 1/1/2017 Visit * * OTNPWT50 OT NPWT > 50 sq cm Occupational Therapy 1/1/2017 Visit * * *$292 is the national average payment amount for the provision and application of a new therapy device. This can be changed to reflect the applicable amount for your agency. CREATE A PART B FINANCIAL CLASS Go to File>File Maintenance>Category. Click Change Type and set to Insurance Class. Press the Add button to add a new Class. Enter the Code as MB and the Description as Medicare Part B Class. 716 Newman Springs Road Lincroft, NJ Tel Page 3 of 6

4 INSURANCE SETUP Go to File>File Maintenance>Entity. Click Change Type and set to Insurance. Press the Add button to add a new Medicare Part B Insurance if one isn t already present. Note: clinical system users should add this in their clinical software and complete the setup in HAS after the record has posted over. On the Name/Address tab, enter a Code, Description and Address (including 9-digit zip). On the Insurance tab, set to the following: Insurance Type: Medicare Rev Type Financial Class : Medicare Part B Class Bill Type : UB04 Payor Type : 1-Medicare (Fee for Service) Next, go back to the Name/Address tab and select the Medicare insurance. On the Ins-Rate tab, add each NPWT charge code as zero dollars covered so the charge will flow to the Medicare Part B payer. 716 Newman Springs Road Lincroft, NJ Tel Page 4 of 6

5 CREATE A NPWT OPTION SET Go to Billing > Electronic Claims and select the Option Set for Medicare PPS. Click the Options button and in the Billing Options Wizard, click Copy. Enter a Destination ID number not already in use and Description of Medicare Part B NPWT. Click OK and then close Electronic Claims. Go to Billing > Electronic Claims and select the Medicare Part B NPWT Option Set. Click the Options button and set the following Locators: CLM*05 Type of Bill: 34S REF*G1 Treatment Authorization Codes: Bypass this Data Element NTE*ADD Comments: Constant Value (Entered) and type NPWT in the text box (if required by your MAC) Charge Itemizations: uncheck Use for all except Skilled Nursing, Physical Therapy and Occupational Therapy. Set the Service-Units to Units and Itemization to Visit Bill Processing Type: Non-PPS NPWT BILLING PROCESS ADD MEDICARE PART B TO PATIENT FILE Patients should have Medicare Part A listed as their primary and the Medicare Part B payer listed as their second insurance in the Patient file, Insurance tab. If billing a co-insurance amount, the co-insurance (or Self Pay insurance) should be added as well. Note: clinincal system users should do this in their clinical system. 716 Newman Springs Road Lincroft, NJ Tel Page 5 of 6

6 ENTER THE NPWT VISIT Go to Charge > Enter/Maintain to add the NPWT visit. The Visit Time entered should be the portion of time spent on dnpwt. Remember, if dnpwt was performed as part of a normally covered Home Health visit, do not include the time spent on dnpwt in the original visit time. Note: clinical system users should do this in their clinical system if supported, otherwise they may add the charge into HAS directly. BILLING & CLAIMS 1. Go to Billing > Billing Pre-Audit and run it for Non-PPS Billing Type choosing the Medicare Part B Financial Class. Correct any Failures, if found. 2. Once done, jump to the Billing Audit and run/post a Normal audit. Note: the RAP for Medicare Home Health episode must be in a Billed status before any visits in the episode, including the NPWT visit can be processed. 3. Go to Billing > Electronic Claims, select the Medicare Part B NPWT Option Set and create the claim for submission. 716 Newman Springs Road Lincroft, NJ Tel Page 6 of 6