Posts

Deadline for Reporting MIPS Postponed

Deadline for Reporting MIPS Postponed

To provide relief to clinicians who are on the front lines of the fight against the 2019 Novel Caronavirus (COVID-19), CMS announced that they will be extending the reporting deadline for MIPS from March 31, 2020 to April 30, 2020. In addition, CMS is evaluating options for providing relief for MIPS participation in 2020.

CMS has also updated the policy for extreme and uncontrollable circumstances ensuring that providers who are unable to report for 2019 at all will not be penalized. In an email sent out by CMS it states the following:

“MIPS eligible clinicians who have not submitted any MIPS data by April 30, 2020 do not need to take any additional action to qualify for the automatic extreme and uncontrollable circumstances policy. These clinicians will be automatically identified and receive a neutral payment adjustment for the 2021 MIPS payment year. All four MIPS performance categories for these clinicians will be weighted at zero percent, resulting in a score equal to the performance threshold, and a neutral MIPS payment adjustment for the 2021 MIPS payment year. However, if a MIPS eligible clinician submits data on two or more MIPS performance categories, they will be scored and receive a 2021 MIPS payment adjustment based on their 2019 MIPS final score.

CMS will continue monitoring the developing COVID-19 situation and assess options to bring additional relief to clinicians and their staff so they can focus on caring for patients.”

The full press release is available at https://cms.gov/newsroom/press-releases/cms-announces-relief-clinicians-providers-hospitals-and-facilities-participating-quality-reporting

For More Information

Please reference the 2019 QPP Data Submission User Guide. CMS also has up to date information about its programs and response to COVID-19 on the Current Emergencies page.

For Quality Payment Program questions you can contact 1-866-288-8292, Monday through Friday, 8:00 AM-8:00 PM ET or by e-mail at: QPP@cms.hhs.gov.

AZCOMP Technologies – the #1 eMDs reseller since 2005.

We are the ultimate source for all things Medisoft & Lytec. Whatever your question or problem or need with Medisoft & Lytec, we can help you. AZCOMP can help with sales, training, coaching, installation, support, EHR, add-on tools such as preferred clearinghouses, or patient statements, patient payments, appointment reminders and more.

For more Medisoft information, visit our website here: http://www.azcomp.com/medisoft/

For more Lytec information, visit our website here: http://www.azcomp.com/lytec/

Be sure to call us at (877) 959-8292 for all your network and healthcare technology needs.

Meaningful Use in 2016

Don’t miss out on what’s happening in 2016 with Meaningful Use!

Providers that wait until 2016 to review what they need to be doing for meaningful use in 2016 may miss the mark!

Remember that unless you are in your first year of participating in the EHR Incentive Program (Meaningful Use), providers will be required to attest for the entire calendar year of 2016. Since there are certain measures that require providers to attest that the functionality was enabled the entire reporting period, there is a high risk to missing the mark. It’s all or none when it comes to meaningful use, therefore we are encouraging providers to take time to review the changes and make sure you are on track well before January 1st. Providers that wait may find it is too late!

Get Started before January 1st!

A great resource to review is this recently released overview document of what has changed in the program and what is REQUIRED in 2016:

Providers are also encouraged to keep supporting documentation at the beginning of the reporting period (January 1st) for yes/no attestation measures, for more information review the Supporting Documentation for Audit Tipsheet from CMS.

Tell me more…

Let us help you along the way. We have many resources available on our blog to help answer questions about the EHR Incentive Program and Meaningful Use. Click here to find previous articles.

Need Any Assistance? Our Trainers Can Help.

training- Help Me banner 3

 

 

 

 

 

 

 

 

Disclaimer: AZCOMP Technologies, Inc, (AZCOMP) is providing this material as an informational reference for eligible professionals. Although every reasonable effort has been made to assure the accuracy of the information within these pages at the time of posting, the Medicare/Medicaid programs are constantly changing, and it is the sole responsibility of each provider to remain abreast of  program requirements by consulting the authorities and documentation found directly at http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html

REMINDER: Final Surescripts Compliance Deadline

This is a reminder of the Surescripts 10.6 Sunset Policy for Routing and Medication History

If you are currently using an older version of Practice Partner, Medisoft Clinical or Lytec MD, and if you plan to continue to send Routing (New e-prescriptions and Refill Requests), Medication History, or Eligibility transactions, you have until June 30th, 2015 to upgrade to an EMR that is compliant with the Surescripts 10.6 protocol.

The compliant versions of EMR that we have available for you are Practice Partner v11.0, Medisoft Clinical v19 SP1, and Lytec MD 2014 SP1.  No previous versions of Practice Partner, Medisoft Clinical or Lytec MD are/will be compliant with the Surescripts requirement.

The Surescripts 10.6 Protocol

The Surescripts 10.6 Sunset Policy for Routing and Medication History is that Surescripts will reject all pre 10.6 or 4010 transactions starting on July 1, 2015.  Users of Medisoft Clinical, Lytec MD and Practice Partner EMR systems have until June 30th, 2015 to upgrade to one of the compliant EMR versions.

Reminder About ICD-10

In addition to the Surescripts requirement, ICD-10 is still scheduled to be implemented in October 1, 2015.  Practices using older versions of Practice Partner, Medisoft Clinical and Lytec MD will need to be on these same updated releases in order to be ready for ICD-10.  So even if you are not affected or using e-prescribing, but continuing to use older versions, those versions will not support ICD-10 coding on October 1, 2015.

Please contact us at (888) 799-4777 if you have any questions or need any help on this matter.

Disclaimer: AZCOMP Technologies, Inc, (AZCOMP) is providing this material as an informational reference for healthcare providers. Although every reasonable effort has been made to assure the accuracy of the information within these pages at the time of posting, the Medicare/Medicaid programs are constantly changing, and it is the sole responsibility of each provider to remain abreast of  program requirements by consulting the authorities and directly from their the source 

 

Guidance on Reporting Menu Objectives for Meaningful Use

Review Updated Information on Reporting Menu Objectives

(This is a repost of an email we received from CMS January 15, 2015)

CMS has released updated guidance on how elegible professionals should select menu objectives for the Medicare and Medicaid Electonic Health Record (EHR) Incentive Programs.  We encourage you to stay informed by taking a few minutes to review the information below.

Guidance on Reporting Menu Objectives

Elegible professionals participating in Stage 1 of the EHR Incentive Programs are required to report on a total of 5 meaningful use objectives from the menu set of 9 objectives.  When selecting five objectives from the menu set, eligible professionals must choose at least one option from the public health menu set.

If an eligible professional is able to meet the measure of one of the public health menu objectives but can be excluded from the other, the eligible professional should select and report on the public health menu objective he or she is able to meet.

If an elegible professional can be excluded from both public health menu objectives, the elegible professional may meet the menu requirement one of two ways:

  1. Claim an exclusion from only one public health objective and report on four additional menu objectives from outside the public health menu set.
  2. Report on five menu objectives from outside the public health menu set

Eligible professionals participating in Stage 2 are required to report 3 meaningful use objectives from the menu set of 6.

We encourage eligible professionals to select menu objectives that are relevant to their scope of practice, and claim an exclusion for a menu objective only in cases where there are no remaining menu objectives for which they qualify or if there are no remaining menu objectives that are relevant to their scope of practice.

For example, we hope that eligible professionals will report on 5 measures, if there are 5 measures that are relevant to their scope of practice and for which they can report data, even if they qualify for exclusions in the other objectives.

The Registration and Attestation System may prompt an eligible professional to report on additional measures if he or she claims an exclusion. This is because starting in 2014, the exclusion criteria will no longer count as reporting a meaningful use objective from the menu set. An eligible professional must meet the measure criteria for the objectives or report on all of the menu set objectives through a combination of meeting the exclusions and meeting the measures.

However, some eligible professionals who elect option 1 above may be asked to report on non-public health measures when they claim that exclusion in the Attestation System. These providers should document this issue for their records, and then claim the exclusion for the remaining measures in order to allow the system to accept their attestation.

For More Information
For more information, read the updated FAQ.

Disclaimer: AZCOMP Technologies, Inc, (AZCOMP) is providing this material as an informational reference for eligible professionals. Although every reasonable effort has been made to assure the accuracy of the information within these pages at the time of posting, the EHR Incentive program is constantly changing, and it is the responsibility of each provider to remain abreast of the EHR Incentive program requirements.

Meaningful Use Well Check

Time for your end of the year Meaningful Use Well Check 🙂

Meaningful Use Well CheckAs 2014 is drawing to a close the window of opportunity is also closing for meeting Meaningful Use requirements in 2014.  This year we have seen changes to the EHR Incentive Program as well as updates released for the software.  Missing any of these changes could put your practice in jeopardy of not qualifying for meaningful use.  Please take a few moments to review some of the basics to make sure your practice is still on track to successfully attesting for 2014!

Review the Flexibility Rule:

CMS is allowing practices that have not had sufficient time to fully implement the 2014 Certified Electronic Health Records Technology (CEHRT), due to delays in availability, the options to attest using 2011 CEHRT. If you qualify for the CEHRT Options under the flexibility rule, determine which Stage you will attest for this year:

  • Stage 1 2013 Definition
  • Stage 1 2014 Definition
  • Stage 2

For an overview of how to determine if you are eligible for the flexibility rule review: Meaningful Use 911 Webinar

Run your Performance Metric Reports

Run your performance metric reports regularly to ensure you are meeting the thresholds! Remember in v11 you can use the drill down capability in the reports to identify which patients are not included in your numerators. In many cases it will not be too late to make corrections in the patient’s chart to ensure that the data is captured properly so that it can be reflected in your performance metrics report.

Review Menu Objectives

Review Menu objectives to ensure you have the right number to report! CMS is no longer allowing users to claim an exemption and have that count towards their total required menu objectives. If you have claimed an exemption in the past make sure you have selected an additional menu objective to attest to this year. For providers in Stage 1 that may find they are short a measure, it is not too late to send out patient reminders and we have a free webinar you can watch to teach you how to do it!

Patient Reminders Webinar

Providers attesting for Stage 1 2014 Definition or Stage 2 must have a patient portal (Webview)

For more information on changes effective this year, view the following CMS document: 2014 Changes Tipsheet

Review CQM Reports

Providers attesting to Stage 1 2014 Definition or Stage 2 must report 9 CQMs this year. Many CQMs require configuration. Some issues have been identified with the CQM reports in v11, please make sure you are on the latest update of the report so you can ensure you are getting the most accurate numbers, contact support right away if you need updates.

For more information review our recent blog post: New Clinical Quality Measures (CQM) Manual Released!

Ensure that you have supporting documentation for the Yes/No Attestation measures

Ensure that you have supporting documentation for the Yes/No Attestation measures. Not all measures have a threshold and therefore there is no performance metric the system can produce on a report to indicate whether the provider met the measure. CMS recommends keeping supporting documentation for each of the Yes/No attestation measures that the provider attests to. Providers should keep copied of supporting documentation for 6 years post attestation in case of an audit. Yes/No Measures include:

ObjectiveAudit ValidationRecommended Supporting Documentation
Drug-Drug/Drug-Allergy Interaction ChecksFunctionality is available, enabled, and active in the system for the duration of the EHR reporting period.One or more screenshots from the certified EHR system that are dated during the EHR reporting period selected for attestation.
Clinical Decision SupportFunctionality is available, enabled, and active in the system for the duration of the EHR reporting period.One or more screenshots from the certified EHR system that are dated during the EHR reporting period selected for attestation.
Protect Electronic Health InformationSecurity risk analysis of the certified EHR technology was performed prior to the end of the reporting yearCopy of a completed security risk analysis that was conducted during the calendar year the provider is attesting for. It can be performed outside of the reporting period but must be completed no earlier than the first of the year, and no later than the last day of the year.
Drug Formulary ChecksFunctionality is available, enabled, and active in the system for the duration of the EHR reporting period.One or more screenshots from the certified EHR system that are dated during the EHR reporting period selected for attestation.
Generate Lists of Patients by Specific ConditionsOne report listing patients of the provider with a specific condition.Report from the certified EHR system that is dated during the EHR reporting period selected for attestation.
Immunization Registries·Data Submission, and Syndromic Surveillance Data SubmissionOne test of certified EHR technology’s capacity to submit electronic data and follow-up submission if the test is successful.
  • Dated screenshots from the EHR system that document a test submission to the registry or public health agency (successful or unsuccessful). Should include evidence to support that it was generated for that provider’s system (e.g., identified by National Provider Identifier (NPI), CMS Certification Number (CCN), provider name, practice name, etc.).
  • A dated record of successful or unsuccessful electronic transmission (e.g, screenshot from another system, etc.). Should include evidence to support that it was generated for that provider (e.g., identified by National Provider Identifier (NPI), CMS Certification Number (CCN), provider name, practice name, etc.).
  • Letter or email from registry or public health agency confirming the receipt (or failure of receipt) of the submitted data, including the date of the submission, name of parties involved, and whether the test was successful.
ExclusionsDocumentation to support each exclusion to a measure claimed bythe provider.Report from the certified EHR system that shows a zero denominator for the measure or otherwise documents that the provider qualifies for the exclusion.

Preparing for Attestation

A few tools that can help you prepare for your attestation are the CMS attestation worksheets and the attestation calculators that allow you to practice attesting to see if you are passing before submitting your actual attestation:

Stage WorksheetCalculator
Stage 1 2013 DefinitionAttestation Worksheet Stage 1 (2013)Stage 1 Calculator
Stage 1 2014 DefinitionAttestation Worksheet Stage 1 (2014)Stage 1 Calculator
Stage 2Attestation Worksheet Stage 2Stage 2 Calculator

Look Ahead!

Just a reminder, as it stands today the reporting period for 2015 is a full calendar year for all providers that have previously participated in the EHR Incentive program. All providers are required to be on the 2014 CERT for the entire reporting period. If you are scheduled for Stage 2 in 2015 please ensure that you have taken proper steps to configure your EHR for the new objectives and requirements.

We are here to help!

If you need assistance with any of the checklist items above please contact us immediately to schedule time with a trainer. The timeframe is limited and schedules are filling up so do not delay!

We know the amount of work each of you have put into making changes to your practice in order to meet meaningful use objectives, and congratulate each of you for taking the steps to ensure your patients are receiving the BEST care!

 

Disclaimer: AZCOMP Technologies, Inc, (AZCOMP) is providing this material as an informational reference for eligible professionals. Although every reasonable effort has been made to assure the accuracy of the information within these pages at the time of posting, the EHR Incentive program is constantly changing, and it is the responsibility of each provider to remain abreast of the EHR Incentive program requirements.

Update: FINAL Surescripts Compliance Deadline

Important News Regarding the Surescripts 10.6 Compliance Deadline

Mid-morning on Friday, October 3, 2014 we received information from McKesson with an update regarding the Surescripts 10.6 Compliance Deadline.  We want to make sure that our customers have the most up to date information so we are passing this information along.

This is the information that we received from McKesson:

FINAL Surescripts 10.6 Compliance Deadline

“Dear Value Added Resellers:

“We have now received a formal message from Surescripts regarding the deadline for compliance with their 10.6 Sunset Policy for Routing and Medication History.  In summary, Surescripts is giving vendors until December 31, 2014, to become compliant with their 10.6 protocol.  [McKesson is] already compliant and has been since early this year.  Our compliant versions are Practice Partner v11.0, Medisoft Clinical v19 SP1, and Lytec MD 2014 SP1.  No other versions of Practice Partner, Medisoft Clinical, or Lytec MD are/will be compliant with this requirement.  Customers have until June 30, 2015 to upgrade to an EMR that is compliant with the 10.6 protocol.  Beginning on July 1, 2015, Surescripts will reject all pre-10.6 or 4010 transactions and only users transacting on 10.6 and 5010A1 will be able to send Routing, Medication History or Eligibility transactions.

“We strongly encourage all customers to upgrade to Practice Partner v11.0, Medisoft Clinical v19 SP1, or Lytec MD 2014 SP1 before the end of the year, and not wait until the deadline.  This not only ensures that they are compliant with Surescripts, but that they are also well positioned.”

McKesson also provided us with this information that is directly from Surescripts:

“Surescripts has worked with many of our customers to ensure compliance with our 10.6 Sunset Policy for Routing and Medication History, as well as Eligibility 5010A1, in support of CMS requirements.  If you are already in compliance, we appreciate your timely attention to this matter, and we recognize that this required a significant amount of work to be in compliance.

“If you are not yet in compliance, please consider this our final notification regarding upcoming deadlines.  In order to support your efforts to finalize your 10.6 deployment, we are granting a final deadline extension through December 31, 2014.  If you are not certified and fully deployed with 10.6 and/or 5010A1 requirements by January 1, 2015, you will be considered “out of compliance”.

“Beginning on July 1, 2015, Surescripts will reject all pre-10.6 or 4010 transactions and only users transacting on 10.6 and 5010A1 will be able to send routing, Medication History or Eligibility transactions.”

Being Prepared For The Future

Again, we want our customers to have the most up to date information and that is why we are posting about this.  If you have not upgraded to the latest version of Medisoft Clinical, Lytec MD or Practice Partner (v11),  you should not delay.  We highly recommend that you prioritize upgrading in the near future to make sure that you are in compliance with Surescripts and in a good position having the latest version of the software.  The only way to ensure that you are compliant with any regulatory changes such as this is to be on the latest version of your EHR software.

A note about Meaningful Use

Lastly, if you plan to meet meaningful use in 2015, that is another reason that you will need to upgrade to the latest EMR version.  Meaningful Use and Surescripts requirements are independent of each other.  You will need to be upgraded prior to January 1, 2015 if you plan to meet meaningful use.

If you need to schedule your version 11 upgrade, or if you have any questions about any of this information, please contact our office at (480) 730-3055.  Another option is that you can leave a comment or a question in the comments section below.  We’ll be sure to answer any questions that you submit.

Disclaimer: AZCOMP Technologies, Inc, (AZCOMP) is providing this material as an informational reference for healthcare providers. Although every reasonable effort has been made to assure the accuracy of the information within these pages at the time of posting, the Medicare/Medicaid programs are constantly changing, and it is the sole responsibility of each provider to remain abreast of  program requirements by consulting the authorities and directly from their the source at http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html

Rule passed to allow flexibility for 2014 in certified EHR technology

It’s Official: The New CMS Rule Has Passed

Update: For a more full description and more detailed information, please read our latest post on this subject.

This past week on August 29th, the Department of Health and Human Services published a final rule allowing more flexibility for 2014 according to a press release.  According to the release, eligible providers can now use a 2011 edition certified EHR technology (CEHRT) or a combination of 2011 and 2014 edition CEHRT for an EHR reporting period in 2014 for the meaningful use Incentive Programs.  However, in 2015 it is required to use the 2014 edition CEHRT for all eligible professionals, eligible hospitals, and critical access hospitals.

This is great because it does allow for some flexibility in how CEHRT’s are used to meet meaningful use for this 2014 reporting year.  Hopefully now more providers will be able to participate and meet important meaningful use objectives.  It should now be easier for more providers to meet objectives like electronic prescribing, providing clinical summaries to patients, drug interactions and drug allergy checks, reporting on quality measures and reporting on key public health data.

The press release also gives some information about how the new ruling finalizes the extension of Stage 2 through 2016 for certain providers and announces the Stage 3 timeline.  The stage 3 timeline will begin in 2017 for providers who first became meaningful EHR users in 2011 or 2012.

Here is an updated meaningful use timeline and a chart with 2011 and 2014 CEHRT Edition options.

Updated Meaningful Use Timeline from the Press Release:

updated meaningful use timline 2014.09.02 from CMS

CEHRT Systems Available For Use In 2014

CEHRT systems available for 2014 per CMS 2014.09.02

 

Need more information about the EHR Incentive Programs?

Make sure to visit the Medicare and Medicaid EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs.  Or you can just go to CMS.gov to get any of the information you need.

Also please note that AZCOMP Technologies, Inc, (AZCOMP) is providing this material as an informational reference for eligible professionals. Although every reasonable effort has been made to assure the accuracy of the information within these pages at the time of posting, the Medicare program is constantly changing, and it is the responsibility of each provider to remain aware and educated of the Medicare program requirements.

 

How Will The Proposed CMS Rule Impact Your Practice? (Join Us For A FREE Webinar)

FREE Webinar – Passed or Rejected?  How the proposed CMS rule will effect your practice.

healthcare software industry updatesDo you know how this proposed measure will impact  your practice?  If you are attesting to meaningful use this year then you need to know the answer to that question.  At this point, we don’t know if the proposed rule will pass or be rejected, but we will find out on July 15th when the proposed rule is scheduled to be voted on.  But once we know if it is passed or rejected….then what?  What will that mean for you and your practice?

On Tuesday, July 22, 2014 at 9:00 AM Pacific, AZCOMP trainer Maggie Delcamp will host a free webinar to cover this very topic.  You won’t want to miss it.  Go to our Registration Page to register.  If that date and time don’t work out for you, then be sure to register anyways and we’ll send you the recording.

Register For The Webinar Button

Webinar Bonus: Documentation Tips That Will Be A Lifesaver In A Meaningful Use Audit

As a bonus for this webinar, Maggie will also cover actions that you can implement right now that will help you in the event you have a MU audit.

We look forward to seeing you there!

 

02/12 CMS 1500 Claim Form and Medisoft v19

Timeline

The NUCC (National Uniform Claim Committee) has approved a transition timeline for the version 02/12 CMS-1500 Claim Form. In June, the NUCC announced the approval of the updated 1500 Claim Form that accommodates reporting needs for ICD-10 and aligns with requirements in the Accredited Standards Committee X12 (ASC X12) Health Care Claim: Professional (837P) Version 5010 Technical Report Type 3.

The NUCC approved the following transition timeline at its in-person meeting in Chicago on August 1, 2013.

  • January 6, 2014: Payers begin receiving and processing paper claims submitted on the revised 02/12 CMS-1500 Claim Form.
  • January 6 through March 31, 2014: Dual use period during which payers continue to receive and process paper claims submitted on the old 1500 Claim Form (version 08/05).
  • April 1, 2014: Payers receive and process paper claims submitted only on the revised 02/12 CMS-1500 Claim Form.

New Claim forms built into Medisoft (as of Version 19 and up):

There are six new claim forms available in Medisoft v19:

  1. CMS-1500 (Primary) – 02/12 W/Form
  2. CMS-1500 (Primary) – 02/12
  3. CMS-1500 (Secondary) -02/12 W/Form
  4. CMS-1500 (Secondary) – 02/12
  5. CMS-1500 (Tertiary) – 02/12 W/Form
  6. CMS-1500 (Tertiary) – 02/12

These forms have been programmed to meet the recommendations for completing the new CMS- 1500 02/12 Claim Form. Forms with the words “W/Form” in the title indicate that the report will print both the claim data and the claim form itself on a white sheet of paper. Note that the form will print in black ink so if you have a payer that requires the form in red you will not be able to use this form. It is our understanding that most payers do accept it in black ink (Medicare being the exception).

The forms that do not have the words “W/Form” in the title are designed to print on a pre-printed claim form. Note that you may have to align the form to your specific printer.

There is no longer a separate form for Medicare claims as all of the forms have been programmed to look at the “Insurance Type” designated on the Insurance setup screen. When the type is set to “Medicare” the form will automatically complete the claim form with according to Medicare specifications for you.

Essentially the only choice you need to make is whether you are printing claims for the primary, secondary, or tertiary insurance and whether you want the claim form itself to print with the data, or if you want the data only so you can print it on a pre-printed claim form.

Changes to the CMS- 1500 Claim Form and where the data will pull from in Medisoft v19 SP1:

This article will only detail the boxes that changed on the new 02/12 form available in Medisoft v19 SP1. Where there are visual changes to the form, the images used in this article will display the 08/05 form is in black and the new 02/12 form will be depicted is in red. If there are no visual changes to the form only a description of the change will be included.

While Medisoft v19 included the new 02/12 forms, Medicare did not release their instructions on how to complete the 02/12 form for Medicare claims until after Medisoft v19 was released. Therefore, only Medisoft v19 SP1 has the 02/12 forms programmed to Medicare specifications. All other insurances can be billed using the forms available in both Medisoft v19 and Medisoft v19 SP1.

The information in this article assumes that the user is on Medisoft v19 SP1. For reference please see the release notes for: Medisoft 19 Release Notes & Medisoft 19 SP1 Release Notes

For instructions on where to obtain Medisoft v19 SP1 see: Medisoft v19 SP1

Form Changes:

___________________________________________________________________

 

Box 1 Insurance Type: Champus has been removed and changed to Tricare, SSN has been removed and replaced with ID.

___________________________________________________________________

Box 2 Patient’s Name: The NUCC suggests not printing the patient’s name when the patient is the subscriber. However, the patient’s name will continue to print on the form.

___________________________________________________________________

Box 4 Insured Name: This box now includes functionality for worker’s compensation. If the Insurance Type of the destination payer is worker’s compensation, the patient case employer name will print.

___________________________________________________________________

Box 5 Patient’s Address: The phone number no longer prints based on the NUCC’s suggestion.

___________________________________________________________________

Box 7 Employer Address: This box now includes functionality for worker’s compensation. If the Insurance Type of the destination payer is worker’s compensation, the patient case employer address will print.

___________________________________________________________________

Note: New Fields have been added to Medisoft v19 to accommodate for changes on the 02/12 form where it indicates “Reserved for NUCC Use”. These fields are located on the Miscellaneous Tab in the Case.

___________________________________________________________________

 

Box 8 Reserved for NUCC use: (Was Patient Status) This box shows the value of the new “Box 8” field on the Miscellaneous tab of the Case window. (New field available only in Medisoft v19)

___________________________________________________________________

Box 9 Other Insured’s Name: For Medicare primary claims: If the primary insurance type is Medicare and the EDI Extra 1/Medigap field for the secondary insurance is Y, then Medisoft will print the subscriber’s name according to the current rule. Otherwise, Medisoft will leave the box blank. This excludes the insurance type of Medicaid when Medicaid is the secondary insurance.

___________________________________________________________________

Box 9a Other Insured’s Policy: For Medicare primary claims: If the primary insurance type is Medicare EDI Extra 1/Medigap field for the secondary insurance is Y, then Medisoft will print the policy number according to the current rule, with the word MGAP preceded before the printed value. This excludes the insurance type of Medicaid when Medicaid is the secondary insurance.

___________________________________________________________________

 

Box 9b Reserved for NUCC use: (Was Date of Birth and Sex) This box shows the value of the new “Box 9b” field on the Miscellaneous tab of the Case window. (New field available only in Medisoft v19)

___________________________________________________________________

 

Box 9c Reserved for NUCC use: (Was Employer or School Name) This box shows the value of the new “Box 9c” field on the Miscellaneous tab of the Case window. (New field available only in Medisoft v19)

For Medicare primary claims:

  • If the primary insurance type is Medicare and the EDI Extra 1/Medigap field for the secondary insurance is Y AND the Plan Name is blank, Medisoft will print the secondary insurance address in the following format on one line.: 1257 Anywhere St. City MD 21204.
  • If the EDI/Extra 1 Medigap field is blank or it has a Y and the plan name has a value, Medisoft will leave this box blank.
  • This excludes the insurance type of Medicaid when Medicaid is the secondary insurance. Otherwise, Medisoft will use the current rules.

___________________________________________________________________

Box 9d Insurance Name: For Medicare primary claims: If the primary insurance type is Medicare and the EDI Extra 1/Medigap field for the secondary insurance is Y, AND the Plan Name field has a value, then Medisoft will print the Plan name value. Otherwise, Medisoft will leave the box blank. This excludes the insurance type of Medicaid when Medicaid is the secondary insurance.

___________________________________________________________________

 

Box 10d Claim Codes (Designated by NUCC): (Was reserved for local use) This box will print multiple condition codes separated by a space. This information reflects information from the “Condition Codes” fields located on the Condition tab in the case.

If the primary insurance type is Medicare and the secondary insurance type is Medicaid, Medisoft will print MCD preceded by the Medicaid policy number.

___________________________________________________________________

Box 11 Insured’s Policy Group or FECA Number:

If the primary insurance is Medicare, NONE will print in this box.

For Medicare secondary claims: When the secondary Insurance type is Medicare, Medisoft will print the Primary Insurance Group Number.

Otherwise, Medisoft will print the insured’s policy group or FECA number This information comes from the Case window, Policy 1, 2, or 3 tab, Group Number field.

___________________________________________________________________

Box 11a Insured’s DOB and Gender:

For Medicare primary claims: If the primary insurance is Medicare, Medisoft will then leave this box blank.

For Medicare secondary claims: If the secondary insurance is Medicare and the subscriber is not the patient, Medisoft will print the subscriber’s birth date.

___________________________________________________________________

 

Box 11b Other Claim ID (designated by NUCC): (Was Employer Name) This box will print the value in the claim number field, preceded by a Y4 qualifier. The Claim Number field is found on the Policy tab in the case.

 

___________________________________________________________________

Box 11c Ins Plan or Program Name: For Medicare secondary claims: When the secondary Insurance type is Medicare, Medisoft will print the Primary Insurance Name. Otherwise, Medisoft will print the insured’s insurance plan name or program name. This information comes from the Insurance Carrier window, Address tab, Plan Name field. If there is no name in the Plan Name field, the insurance carrier name prints in this box.

___________________________________________________________________

Box 11d Is there another health benefit plan? If the primary insurance is Medicare, this box will remain blank. Otherwise, if there is a value in the Insurance field of the Policy 1 or 2 tab in Cases, the Yes check box is selected. If that value is empty, the No check box is selected.

___________________________________________________________________

 

Box 14 Date Current Illness Injury or LMP: In addition to the date, there is a new Qualifier Code. The date will pull from the “Injury/Illness/LMP Date” field on the Condition tab in the case.  The qualifier will populate based on the option selected for the “Illness Indicator” field on that same tab.

 

For Medicare primary and secondary claims: If Insurance type is Medicare, Medisoft will not print a qualifier in the qualifier section of the box. Current rules apply for the date.

___________________________________________________________________

 

Box 15 Other Date: In addition to the date (selected based on which date field is completed on the Condition tab in the case in the order below), there is a new Qualifier Code:

 

If more than one of these is completed on the condition tab in the case, Medisoft will print the first one in the order listed above.

 

___________________________________________________________________

 

Box 17 Referring Provider: This box can be used for various physician types. There are new qualifiers indicating the physician’s type:

 

  • Only one can be used. If more than one exists on the billing, the system will use the following order: 1. referring, 2. ordering, 3. supervising.
  • If both supervising and referring exist on the claim (pulled from the Account tab in the case), Medisoft will print the referring provider.

 

  • If the Send Ordering Provider in Loop 2420E check box on the destination payer’s Insurance record (EDI- Eligibility tab) is selected and there is a referring physician, Medisoft will print DK (Ordering Provider) instead of DN.

 

Box 17a Other ID: This box shows the ID of the provider from Box 17.

___________________________________________________________________

Box 17b NPI Number: This box shows the NPI number of the provider from Box 17.

___________________________________________________________________

 

Box 19 Additional Claim Information (designated by NUCC): (Was reserved for local use) Additional Claim Information (designated by NUCC)

  • If there is a Taxonomy Code in the Provider ID grid for the provider in Box 24j, Medisoft will use that information first for Box 19. The qualifier ZZ followed by the taxonomy value will print. For example, ZZ163WG0100X.
  • If there is a value in the Legacy Identifier 2 field for that provider, the Legacy Identifier 2 qualifier and value will print. For example, 0B98765466.
  • If the Payer type is Worker’s Comp, three blank spaces and the Transaction Entry EDI notes for PWK, in addition to the IDs listed above, will print.
  • If none of these conditions are met, Medisoft will print the value in the Local Use B field on the Case – Miscellaneous tab.

___________________________________________________________________

 

Box 21 Diagnosis Codes: Diagnosis codes 5-12 (indicated as E-L) have been added. Diagnosis codes are listed in order from left to right on three lines with four codes per line. In addition, there is an ICD Code Set Indicator:

 

___________________________________________________________________

Box 23 Prior Authorization Number: If there is no Prior Authorization Number, the Claim
Facility CLIA Number will print.

___________________________________________________________________

Box 24e Diagnosis Codes: This value now accepts alpha characters. Previously, only numeric values were reflected.

___________________________________________________________________

Box 24h EPSDT: Unshaded area: A Y will print if the EPSDT check box on the Case window – Medicaid-Tricare tab is selected, unless Code 1 of the EPSDT Referral Codes is populated. In that case, the code will be printed instead of Y.

Shaded area: If the EPSDT check box is selected and the Family Planning check box is selected, Y will be printed. If EPSDT is selected and Family planning is not, N will be printed.

___________________________________________________________________

Box 24 Transaction Description: Shaded area: If an NDC code is used, N4 will be printed and then the transaction NDC Code, a single space, followed by the NDC Unit of Measurement and NDC Unit Count. If you have entered text in the description field for a transaction, ZZ followed by the transaction description will print. If both are used, the NDC information prints first.

___________________________________________________________________

Box 29 Amount Paid: This field is left blank. On secondary claims, it will show the calculated amount paid by the primary insurance carrier.

___________________________________________________________________

30

Box 30 Balance Due: No longer used.

___________________________________________________________________

We highly recommend studying both the 02/12 1500 Instruction Manual found at Nucc.org and the Medisoft Release Notes found here: Medisoft 19 Release Notes

Note: Medicare did not release the instruction manual for the new CMS-1500 02/12 Form until after Medisoft v19 was released. Therefore, users will need to install Medisoft v19 in order to print a paper claim formatted to Medicare’s specifications. Links to download SP1 can be found here. The Medisoft 19 SP1 Release Notes contain instructions on how Medisoft v19 SP1 populates the claim form for Medicare.

DISCLAIMER: Although AZCOMP Technologies, Inc. makes every effort to ensure that information regarding billing guidelines are checked and accurate in both our documentation and training, it should be understood that our expertise is in the software itself and not in billing practices. Therefore, it is the sole responsibility of the user to study, interpret and remain abreast of billing requirements and deadlines, contacting authoritative sources directly as needed. Any claims documentation and training provided by AZCOMP Technologies, Inc. is based on our interpretation of the rules published by nucc.org and cms.gov and  are subject to change. Information and training provided is “as is” and without any express or implied warranties. AZCOMP Technologies, Inc. assumes no responsibility for any inaccuracies, errors, or omissions, expressly disclaiming liability for damages of any kind arising out of the use of, reference to or reliance on any content provided.

Interactive CMS Form Only in Medisoft 19 or Lytec 2014

As many know, as of April 1, 2014 claims will no longer be accepted on the traditional CMS 1500 form also known as the HCFA form. The new CMS 1500 02/12 is only compatible with Medisoft v19 and Lytec 2014.

There is an interactive guide in Medisoft 19 and Lytec 2014 to help you understand where each new field pulls from. To find this helpful guide open up the help menu and search “clickable” this will pull up the interactive guide to the CMS form.

There are several articles on our blog with information about the CMS form- so click on the tag “CMS” for more info.

clickable