lesson 1 overview of the 837 and 835. 2 section 1: overview introduction how did we get to where we...
TRANSCRIPT
Lesson 1
Overview of the 837 and 835
2
Section 1: Overview
• Introduction
• How did we get to where we are now?
• What do electronic transactions mean to you and your coworkers?
• How is IHS making it easy for you?
• Where are we now?
3
Whom Do Electronic Transactions Affect?
• Successful electronic transactions require action from: – Patient
Registration
– Business Office
– Finance
4
Section 1: Overview
• Introduction
• How did we get to where we are now?
• What do electronic transactions mean to you and your coworkers?
• How is IHS making it easy for you?
• Where are we now?
5
Why Electronic Transactions?
• Makes good business sense
– Revenue will increase
– Cash flow will even out
– It supports mission of providing highest quality health care to all American Indians, Alaska Natives, and those served by urban facilities
6
Why Electronic Transactions? (cont’d)
• Addresses important patient rights issues– Privacy
• Protects patient records so only the right people have access to them
– Accountability• System tracks who accesses records
and when
– Efficiency• Reduces time spent on paperwork
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Why Electronic Transactions? (cont’d)
• It’s the law– In 1996 Congress passed Health Insurance
Portability and Accountability Act (HIPAA)
– HIPAA includes section on Administrative Simplification
• Makes possible electronic transmissions using standard record formats, code sets, and identifiers
– No specified date for compliance• But members should show “good faith efforts”
working toward compliance
8
• Transaction and Code Set Standards (Final)
• Privacy Standard (Final)
• Security Standard (Final)
• National Provider Identifier Standards (Final)
DHHS Rules Defining HIPAA
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Focus of Training: 837 and 835
• Health Claims & Equivalent Encounter Information or the 837
• Health Care Payment & Remittance Advice or the 835
New and Old Formats
837I(Institutional)
replaces UB-92
837P(Professional)
replaces HCFA-1500
837D(Dental)
replaces ADA forms
837COB (Coordination
of Benefits)
Used to submit claims to secondary payers
835 replaces NSFforms
10
Section 1: Overview
• Introduction
• How did we get to where we are now?
• What do electronic transactions mean to you and your coworkers?
• How is IHS making it easy for you?
• Where are we now?
11
What Does It Mean For You?
Site Manager: “Each year it has increased our collections dramatically.”
Financial Management Officer: “This really helps identify problems.”
Accounting Officer: “You will know exactly what’s going on.”
12
Section 1: Overview
• Introduction
• How did we get to where we are now?
• What do electronic transactions mean to you and your coworkers?
• How is IHS making it easy for you?
• Where are we now?
13
How IHS Makes It Easy For You
• The RPMS tools you need are ready
• The materials you need are on hand
• Problem solving is ongoing and best practices are being developed
• Help is available
14
RPMS Tools Are Ready
Transaction Tool
837-Third Party Billing and 835-Accounts ReceivableGeneric Interface Software (GIS)
GIS v3.01, p2 & p5 (Optional)
837-Third Party BillingInstitutional, Professional and Dental Claim Requests
3rd Party Billing, v2.5, p6
837-Third Party BillingProvider/Location Taxonomy
AUT Patch v98.1, Patch 13
837-Third Party Billing Manually Adding Provider Taxonomy provides instructions to add provider and location taxonomy codes. As a backup, third party RPMS software (3P) uses crosswalk to find taxonomy number.
997 Functional Acknowledgement and Comp Report
Macro has been developed to convert error report format into a list of segment lines for easier interpretation.
835-Accounts ReceivableClaim Replay, (Remittance Advice)
Accounts Receivable, v1.7, p4
835-Accounts ReceivableStandard Adjustment/Reason Codes
Accounts Receivable, v1.6, p4
15
Materials Are On Hand
• HIPAA Compliance: Business Transactions (for Area HIPAA Coordinators)
• Trailblazers Medicare Part A: 837 Testing and Production Procedures (sent to all Area Offices)
• Trailblazers Medicare Part B: 837 Testing and Production Procedures (sent to all Area Offices)
• HIPAA 835 Testing and Production Procedures (sent to all Area Offices)
16
What Does It Mean For You?
Management Program Analyst: “We want everyone to become HIPAA compliant, and this is a tool to help sites get to that point.”
17
Focus of This Training
• 837: Preparation for Testing
• 837: Electronic Claims Submission
• 837: Reading Error Reports and Making Corrections
• 835: Testing and Posting the Remittance Advice
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Problem-Solving Ongoing
• Regular OIT internal technical meetings
• OIT holds regular national I/T/U conference call to discuss Area status reports, issues and solutions, and best practices– To participate in this call, notify ITSC
Help Desk http://www.ihs.gov/GeneralWeb/HelpCenter/Helpdesk/index.cfm
19
Help Is Available
• OIT Help Desk
20
Section 1: Overview
• Introduction
• How did we get to where we are now?
• What do electronic transactions mean to you and your coworkers?
• How is IHS making it easy for you?
• Where are we now?
21
Current Testing Status
22
What Does It Mean For You?
Financial Management Officer: “It will be a whole lot easier for everybody.”
Accounting Officer: “Just keep on moving forward because you’ll come out successful.”
23
Lessons Learned
• Electronic transactions are required:– For good business practice
– To protect patient rights
– By law
• IHS provides:– RPMS tools
– Training materials
– Problem-solving and help