CMS Change Request 8358 User Guide Required April 1, 2014 Cnsl Services CMS Change Request 8358 User Guide P a g e 1
CMS Change Request 8358 Required April 1, 2014 User Guide Overview: CMS Change Request (CR) 8358 requires Claims t include mre details relating t the fllwing areas f prviding Hspice Care: Medicatin Fill Data Injectable Prescriptin Drugs Nn-injectable Prescriptin Drugs Infusin Pumps and Infusin Drugs Pst Mrtem Visits Visits Cmpleted n Date f Death fr the fllwing Types f Hspice Emplyees Nurses Hspice Aides Scial Wrkers Therapists Facility Details Natinal Prvider Identifier (NPI) and 9 digit Zip Cde f the Nursing Facility, Hspital, r Hspice Inpatient Facility where patient receives services General inpatient Care (GIP) Visit Details Line item visit data fr hspice staff prvided under general inpatient care (GIP) in skilled nursing facilities (SNF) r hspitals This User Guide defines the prcesses within Cnsl t meet the specificatin f CMS Change Request 8358. Please refer t the Help Menu / Training Vides fr further Training pprtunities. Cnsl Services CMS Change Request 8358 User Guide P a g e 2
CMS Change Request 8358 Medicatins General Infrmatin Cnsl Services CMS Change Request 8358 User Guide P a g e 3
Medicatins Ppulating Claims with Details Relating t CMS Change Request 8358 The Cnsl Services Team has established slutins fr meeting the updated reprting requirements set frth by CMS in Change Request 8358. CMS is requesting Hspice prviders display the fllwing details n claims prcessed fr Hspice Medicare Part A Beneficiaries: Details frm CMS: Reprt Injectable Drugs Line-item bill per Medicatin Fill Revenue cde = 0636 HCPCS cde fr drug - See list at http://www.cms.gv/medicare/cding/hcpcsreleasecdesets/dwnlads/drug201 4.pdf Units = amunt filled based n HCPCS descriptin Example: HCPCS Q1234 is fr 100 mg, and fill was 200 mg, reprt 2 units Charges Service Date Example frm CMS: Reprt Nn-Injectable Drugs Line-item bill per Medicatin Fill Revenue cde = 0250 Natinal Drug Cde (NDC) List available at: http://www.fda.gv/drugs/infrmatinndrugs/ucm142438.htm Quantity - NDC qualifier is quantity f drug filled, reprted as unit f measure Charges Service Date NDC is reprted - 11 digit NDC (n hyphens) Cnsl Services CMS Change Request 8358 User Guide P a g e 4
Reprt Nn-Injectable Drugs (Cntinued) Unit f Measurement Qualifier F2= Internatinal Unit GR = Gram ME- Milligram ML = Milliliter UN = Unit Reprt Infusin Pumps and Infusin Drugs Line-item bill per Pump Order Line-item bill per Medicatin Refill Revenue Cdes = 0291 (pump, rented); 0292 (pump, new); 0293 (pump, used); and 0294 (drugs) HCPCS = apprpriate cde See list f HCPCS fr drugs at: http://www.cms.gv/medicare/cding/hcpcsreleasecdesets/dwnlads/drug201 4.pdf Units Charges Service date Example frm CMS: Cnsl Services CMS Change Request 8358 User Guide P a g e 5
Cnsl Methds fr Ppulating Claims with Medicatin Details Cnsl has develped three methds t btain the Medicatin Fill Data frm pharmacies and add it t Claims t meet the specificatins defined by CMS in Change Request 8358. The three methds are summarized belw and the cmplete prcesses are defined in the pages that fllw: Methd I - Autmated Claims Integratin with Pharmacy Benefit Managers Cnsl is wrking with a number f Pharmacy Benefit Managers (PBMs) t autmate the Medicatin Fill data int Cnsl. The PBMs are able t send data in a specific frmat via secure transprt, including the Patient ID, directly t Cnsl s Integratin Netwrk. Ntify Integratins@cnslservices.cm t begin the implementatin with yur PBM. Methd II - CSV File Uplad Capability Cnsl has prvided a CSV file frmat that can be shared with lcal pharmacies. The pharmacies can prvide a file in the required frmat that may be upladed int Cnsl. Cnsl has created a dcument with file specificatins that may be distributed t lcal pharmacies s hspices may wrk with them with the gal f btaining medicatin details in the prper frmat fr uplad. Please find the Retail Pharmacy CSV Uplad dcument and a Sample CSV File in the Help Menu / Release Ntes Area. Methd III - Data Entry Cnsl is ffering a data entry screen within the system where Medicatin Fill Data may be manually entered. This methd may be used fr medicatin details frm lcal pharmacies that will nly prvide the infrmatin in paper frmat. Identifying Patients t Pharmacies and Pharmacy Benefit Prviders (PBMs) Patient Identificatin Number The Patient Identificatin Number data is unique and prperly identifies Patients within Cnsl. This number is critical t prvide t Pharmacies relating t ppulating Medicatins n Claims, as required by CMS CR 8358. The Patient Identificatin Number is the Unique Number listed in the Patient URL r Web Address that als lists n: Patient Search Filter Faxed Dcuments Patient Hme Page Header by the Patient Name Mre Buttn n the Patient Hme Page Face Sheets Active Patient Summary Medicatin Reprt Nte: It is critical t identify Patients t Pharmacies and PBMs using the Patient Identificatin Number in rder t prperly assciate Medicatins t Cnsl Patients. Cnsl Services CMS Change Request 8358 User Guide P a g e 6
Examples f the Patient Identificatin Number (the Number frm the URL): Patient Hme Page (After Patient Name) Mre Buttn Details (frm the Patient Hme Page) Cnsl Services CMS Change Request 8358 User Guide P a g e 7
Search Screen Filter Active Patient Summary Reprt Cnsl Services CMS Change Request 8358 User Guide P a g e 8
Security - Rle Changes Medicatin Fill A new Sectin appears in the Rles Screen fr Medicatin Fills. These ptins handle the new functinality relating t CMS CR-8358 allwing the Hspice t track Medicatin details and csts assciated with each patient. Cnsl Services CMS Change Request 8358 User Guide P a g e 9
CMS Change Request 8358 Ppulating Medicatin Data n Claims Methd I - Autmated Integratin With Pharmacy Benefit Managers Cnsl Services CMS Change Request 8358 User Guide P a g e 10
Medicatins Ppulating Claims with Details Relating t CMS Change Request 8358 Methd I - Autmated Claims Integratin with Pharmacy Benefit Managers (PBMs) Cnsl is wrking with a number f Pharmacy Benefit Managers (PBMs) t autmate the Medicatin Fill data int Cnsl. The PBMs are able t send the data in a predetermined frmat via secure transprt, including the Patient ID, directly t Cnsl s Integratin Netwrk. If a Hspice PBM interfaces directly with Cnsl, the Medicatin Details will be autmatically ppulated in Cnsl. It will be necessary t verify there are n PBM Imprt Exceptins by ding the fllwing: G t the Patient Menu Select the Medicatin Fill Recrds G t Related Links Select View PBM Imprt Exceptins Cnsl Services CMS Change Request 8358 User Guide P a g e 11
View the Medicatin Exceptin t Evaluate and Crrect Issues Click Enter Medicatin Fill t Open an Edit Screen t Crrect Issues Cnsl Services CMS Change Request 8358 User Guide P a g e 12
Crrect Issues and Save Nte: Exceptins shuld be reviewed prir t prcessing claims and may nt be deleted Cnsl Services CMS Change Request 8358 User Guide P a g e 13
CMS Change Request 8358 Ppulating Medicatin Data n Claims Methd II - CSV Uplad Capability Cnsl Services CMS Change Request 8358 User Guide P a g e 14
Medicatins Ppulating Claims with Details Relating t CMS Change Request 8358 Methd II - CSV File Uplad Capability Cnsl has created a dcument with file frmat specificatins that may be distributed t lcal pharmacies s hspices may wrk with them with the gal f btaining medicatin fill details in the prper frmat fr uplad. Please find the Retail Pharmacy CSV Uplad dcument and a Sample CSV File in the Help Menu / Release Ntes Area. Sample CSV (Clumn sizes are reduced in this sample) Nte: Retail Pharmacies may create a CSV file in the frmat abve and it may be imprted int Cnsl r a Hspice may type the data nt the CSV File and imprt it int the system Cnsl Services CMS Change Request 8358 User Guide P a g e 15
CSV Files Created Manually Pages 15 18 describe hw t dwnlad the CSV File Template s a Hspice may manually enter medicatin fill data and then uplad it int Cnsl. A hspice wuld use this methd if a Pharmacy des nt prvide the data in the prper frmat. CSV Files Created by a Pharmacy Page 20 describes hw t Uplad a CSV File frm a CSV file created by a Pharmacy (and a file that a Hspice Manually Entered). T Dwnlad a cpy f the CSV File Template frm Cnsl and Enter Data fr Uplad: G T the Patient Menu Select Medicatin Fill Recrd G t Related Links Select Imprt frm CSV Cnsl Services CMS Change Request 8358 User Guide P a g e 16
Select Display Field Infrmatin t Learn Mre abut the Fields in the CSV File Descriptins f Fields n the CSV Imprt File Display n the Screen Cnsl Services CMS Change Request 8358 User Guide P a g e 17
Select Dwnlad Template Sample CSV Template Nte: Patient Names and ID Numbers will display n the CSV file fr all active Patients within the last 45 days (names may be deleted as needed and rws can be added fr multiple medicatin fills per patient) Cnsl Services CMS Change Request 8358 User Guide P a g e 18
Enter Medicatin Data Ntes: NDC Cdes cannt cntain Dashes and must be11 Digits. Shrter numbers will be pre-filled with zeres. All drugs must cntain the NDC. Injectable and infusin drugs als have a HCPCS Cde, but if the HCPCS field is left blank, Cnsl will fill the HCPCS field frm the NDC data. Infusin Pumps d nt have an NDC and require a HCPCS cde. Cmpunds shuld be listed as separate line items but shuld have the same Rx Number. Only Prescriptin Drugs (Rx=Y) display n Claims. Save File The File Must be Saved as a CSV (Cmma Delimited) File Nte: A CSV File may be saved in Excel Cnsl Services CMS Change Request 8358 User Guide P a g e 19
Uplading a CSV File frm a Pharmacy r a CSV a Hspice Manually Entered Select Chse File Select File Select Uplad Cnsl Services CMS Change Request 8358 User Guide P a g e 20
Nte: Errrs appear n the screen in Red, the entire spreadsheet will need t be upladed again nce errrs are crrected, (nne f the data will imprt) Crrect the CSV File and Re-Uplad The Screen belw shws a successful imprt Nte: Recently Entered r imprted Medicatin Fills List n the Page Cnsl Services CMS Change Request 8358 User Guide P a g e 21
CMS Change Request 8358 Ppulating Medicatin Data n Claims Methd III - Data Entry Cnsl Services CMS Change Request 8358 User Guide P a g e 22
Medicatins Ppulating Claims with Details Relating t CMS Change Request 8358 Methd III - Data Entry Medicatin Fills may be Created frm a Patient Hme Page r frm the Patient Menu Enter Data frm the Patient Menu if entering Medicatins fr several Patients G T the Patient Menu Select Medicatin Fill Recrds T Enter Data frm a Patient Hme Page G t a Patient Hme Page Open the Medicatin Area Select Medicatin Fill Recrd The page will pen t the Medicatin Fill Summary Page Select Create a New Medicatin Fill Cnsl Services CMS Change Request 8358 User Guide P a g e 23
Cmplete Data Entry Fields Create and Cntinue Adding Medicatin Fills Ntes: The Patient Name Field des nt appear if accessing frm the Hme Page All Drugs must cntain the NDC. Type the medicatin name r NDC in the Medicatin Lk-up sectin t find the crrect drug. Injectable and Infusin drugs als have a HCPCS Cde, but if the HCPCS field is left blank, Cnsl will fill the HCPCS field frm the NDC data. Fr Infusin Pumps use the HCPCS Cde Lk-up instead f the Medicatin Lk-up. Quantity wuld be the number f pills, patches, vials, etc. D nt enter dsages here. Only Prescriptin Drugs display n Claims. Un-check the Prescriptin checkbx fr OTC drugs. If a Pharmacy r DME Supplier cannt be fund in the Lk-up, g t the Services menu and add it. Individual ingredients f cmpunds shuld be entered as separate drugs and must have the same Prescriptin Number. Cnsl Services CMS Change Request 8358 User Guide P a g e 24
Select Medicatin Fill Recrds (frm the Breadcrumbs) t Return t the Summary Page Summary Page Hand Keyed and CSV Upladed Medicatin Fills may be Edited frm this page Nte: Medicatins will flw t the Claim autmatically The Hspice Claims Team will nt need t d anything t ppulate Medicatin Details during the Claims Prcess Cnsl Services CMS Change Request 8358 User Guide P a g e 25
CMS Change Request 8358 Medicatins Preparing fr Claims Prcessing Cnsl Services CMS Change Request 8358 User Guide P a g e 26
Cmpare Against Medicatin Recrds Cmpare Medicatins that have been filled are in the Medicatin Recrd: G T the Medicatin Fill Screen Select Related Links Select Cmpare Against Medicatin Recrds Verificatin that Medicatins Filled are in the Medicatin Recrd Click Cpy t Med t Add Medicatin t the Medicatin Recrd Add Medicatin Details fr the Medicatin Recrd Cnsl Services CMS Change Request 8358 User Guide P a g e 27
Reversing an Entry (Required if a change is needed t Hand Keyed r CSV Upladed Entries if a Claim has been Prcessed) G t a Patient Hme Page Open the Medicatin Area Select Medicatin Fill Recrd The page will pen t the Medicatin Fill Summary Page Click Icn t View Medicatin Fill Recrd Cnsl Services CMS Change Request 8358 User Guide P a g e 28
G t Related Links Select Create Reversal Select Yes Create the Reversal Cnsl Services CMS Change Request 8358 User Guide P a g e 29
Sample f a Reversal Claim Sample Details Regarding Medicatin Fill Recrds: Interfaced Medicatin Fill Recrds may nt be deleted, but may be edited if there is an exceptin t be crrected. Imprted Medicatin Fill Recrds may be edited, deleted, and reversed. Hand-keyed Medicatin Fill Recrds may be edited, deleted, and reversed. Medicatin Fills f any type may nt be deleted r edited if assciated t a Claim. Incrrect Medicatin Fills must be reversed and a crrect Fill can then be entered. Cnsl Services CMS Change Request 8358 User Guide P a g e 30
CMS Change Request 8358 Facility and GIP Visit Details fr Claims Cnsl Services CMS Change Request 8358 User Guide P a g e 31
Facility and GIP Visit Details Ppulating n Claims Relating t CMS Change Release 8358 GIP Visit Details CMS Change Request 8358 requires that when the site f service is a Skilled Nursing Facility, Hspital, Lng Term Care Hspital r Inpatient Psychiatric Facility, visits are reprted by the number f units fr all fur levels f care including General Inpatient Level f Care. The changes will be visible n the claims and will nt impact charting. Details frm CMS: Claim Line item Reprting f GIP Visits in SNF (Q5004) r Hspital (Q5005, Q5007, Q5008) Applies nly t visits prvided by hspice staff Visits by nn-hspice staff still nt reprted Each Visit is Reprted n a separate Revenue Cde Line Units reflect duratin f visit, 15-minute increments Visits under GIP in an inpatient hspice unit (Q5006) are still reprted weekly Sample frm CMS: Facility Details CMS Change Request 8358 requires a 9 Digit Zip Cde and Facility NPI fr all Medicare claims when the patient is in ne f the fllwing Facility Types and the NPI f the facility is different frm the Hspice NPI: Lng Term Care Nn-Skilled Nursing Facility Skilled Nursing Facility Hspital Lng Term Care Hspital Inpatient Psychiatric Facility Inpatient Hspice Facility Hmecare Hspice Facility Cnsl Services CMS Change Request 8358 User Guide P a g e 32
Details frm CMS: Required Reprting f Natinal Prvider Identifier (NPI) t identify Nursing Facility, Hspital, r Hspice Inpatient Facility Lcatin where Patient Receives Services Reprt name, address and NPI Claims withut NPI will be returned t prvider (RTP) If care prvided in mre than ne facility in a billing mnth, reprt NPI where Patient last treated Claims reprting Q5003, Q5004, Q5005, Q5007 r Q5008 withut NPI will be returned t prvider (RTP) Crrecting Claim Errrs in Cnsl Cnsl checks claims t verify the NPIs and 9 digit Zip Cdes are present. Claims display errr messages when the Facility NPI and 9 digit Zip Cdes are missing. T crrect errrs, please G t the Services Tab, Edit the Facility and d the fllwing: Missing Facility NPI Number Errr - Add the NPI Number Missing Facility 9 Digit Zip Cde Errr Add the 9 Digit Zip Cde, then d the fllwing: G t the Patient Hme Page Open the Change in Care Area Edit/Save the Care Level Change s that the new Zip Cde is displayed Repair the Claim and Send Nte: T prevent Medicare Claim Rejectins please ensure that the Facility Types defined abve cntain a nine Digit Zip Cde and an NPI. Prir t Creating Claims, Run the Active Patient Summary Reprt t verify Zip Cdes fr the Facility Types listed abve are 9 digits. Cnsl Services CMS Change Request 8358 User Guide P a g e 33
Claim Sample Cnsl Services CMS Change Request 8358 User Guide P a g e 34
CMS Change Request 8358 Pst Mrtem Visit Details fr Claims Cnsl Services CMS Change Request 8358 User Guide P a g e 35
Pst-Mrtem Mdifier (PM) Ppulating n Claims Relating t CMS Change Release 8358 When charting fr the Date f Death, Visits which span the time f death shuld be entered as tw separate visits s they may be reprted separately n claims. Details frm CMS: Reprt Visits that ccur after Death and n Date f Death Includes hspice-emplyed nurses, aides, scial wrkers, and therapists Regardless f level f care, r site f service Billing requirements include: Revenue cde HCPCS cde Mdifier PM Units (15-minute increments) Charges Service date Visits subsequent t date f death are nt reprted Sample frm CMS Cnsl Services CMS Change Request 8358 User Guide P a g e 36
Example f Pst Mrtem Prcess within Cnsl Creating Tw Visits: Discharge Due t Death is 2/05/2014 0800 - Visit starts at 0600 and ends at 1200 Enter the Date and Time f Death in the Change in Care Screen Visit #1 - Enter ne visit frm 0600 t 0759 Cnsl Services CMS Change Request 8358 User Guide P a g e 37
Visit #2 - Enter the secnd visit frm 0800 t 1200 (Visit must be n Date f Death, beginning at Time f Death r after t be classified as Pst Mrtem n the Claim) Clinical Chart Summary Screen The first visit will nt be labeled as Pst-Mrtem, but the secnd ne will be classified as Pst Mrtem n the Claim. T determine which visits are labeled as Pst-Mrtem n the claim, the system will cmpare the Time In f the visit t the Effective Date/Time f the Discharge Due t Death Change in Care Entry. Ntes: The Time f Death displayed inside the Discharge Tab f the Care Level Change Screen is nt used fr Pst Mrtem Visits If the visit is n r after the Discharge Due t Death Date and Time, the visit will be labeled with a PM mdifier n the claim If the visit starts prir t the Discharge Due t Death Date and Time, it will lk like any ther visit n the claim. Pst Mrtem Visits that pass midnight n the Date f Death shuld have a time ut f 11:59 and an additinal entry shuld be created fr the Day after Death, this visit will nt be included n the claim Cnsl Services CMS Change Request 8358 User Guide P a g e 38
Pst Mrtem Reprting Medicare Visit Summary Reprt The Medicare Visit Summary Reprt will identify which visits are Pst Mrtem and this reprt may be used t verify Pst Mrtem Visits are entered accurately prir t prcessing claims. Pst Mrtem Visits may be identified frm the Patient Clinical Charting Summary Page: Filter fr Pst Mrtem = Yes Pst Mrtem Symbl Claim Example: Cnsl Services CMS Change Request 8358 User Guide P a g e 39