December, 16, 1999

Medi-742-99

TO: ALL MEDICARE PROVIDERS

SUBJECT: PROPER REPORTING AND ACCEPTANCE OF NON-COVERED CHARGES AND RELATED REVENUE CODES

PRIMARY INTEREST: BUSINESS OFFICE MANAGERS

EFFECTIVE DATE: DATES OF SERVICE ON OR AFTER OCTOBER 1, 2000

MEDI 734-99 (11/16/99) CONTAINED INFORMATION REGARDING THE BILLING OF NON-COVERED CHARGES. THE HEALTH CARE FINANCING ADMINISTRATION HAS RE-ISSUED THESE INSTRUCTIONS WITH A NEW EFFECTIVE DATE. THE ENTIRE TEXT IS BEING REPRODUCED. ONLY THE EFFECTIVE DATE HAS BEEN CHANGED.

The Health Care Financing Administration has published the following guidelines effective with claims with dates of service on or after October 1, 2000.

Instructions for Processing Part B Outpatient Claims (Partial Non-Covered)

Providers are to report on the UB-92 (Form HCFA-1450) (along with covered charges) all Part B outpatient non-covered charges, related revenue codes, and HCPCS codes, where applicable. (Providers should not report the non-payment codes outlined below.) Providers utilizing the UB-92 flat file use record type 61, Field No. 10 (outpatient total charges) and Field No. 11 (outpatient non-covered charges) to report these charges. Providers utilizing the hard copy UB-92 report these charges in Form Locator (FL 47) "Total Charges," and in FL 48 "Non-Covered Charges."

Providers utilizing the electronic X12 institutional claim transaction 837, version 3051 report the following:

X12 837, version 3051, implementation 3A.01

2 395 SV203 - Outpatient Total Charges

2 395 SV207 - Outpatient Non-covered Charges

X12 837, version 3051, implementation 1A.C1

2 375 SV203 - Outpatient Total Charges

2 375 SV207 - Outpatient Non-covered Charges

Instructions for Processing Part B Outpatient Claims (Total Non-Covered)

Providers are to submit outpatient claims when all of the charges on the claim are non-covered (no-payment bill). Providers complete all items on a no-payment bill in accordance with instructions for completing payment bills with the exception that all charges are reported as non-covered. Total the charges under revenue code 001 (total and non-covered.) Non-payment codes are required where no payment is made for the entire claim.

 Beginning October 1, 2000, this instruction will supersede current guidelines which state that for outpatient Part B billing, only charges believed to be covered are submitted in FL 47 and that non-covered charges are omitted from the bill.

THIS BULLETIN SHOULD BE SHARED WITH ALL HEALTH CARE PRACTITIONERS AND MANAGERIAL MEMBERS OF THE PROVIDER STAFF. NO COST COPIES ARE ALSO AVAILABLE FROM OUR WEB SITE AT riverbendgba.com

Please refer any questions to our office at (423) 755-5950.

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