Billing the 08 Condition Code Teleconference ... - WPS Medicare

Billing Condition Code 08 Teleconference
February 21, 2013
Agenda
‣ Medicare Secondary Payer (MSP) Basics
‣ When to use Condition Code (CC) 08
‣ When not to use Condition Code (CC) 08
‣ Coding for MSP claims
Medicare Secondary Payer (MSP) Basics
‣ Benefits of MSP Program
Medicare Trust Fund – protects trust fund and saves taxpayer money
Providers – increases revenues
Beneficiaries – lower out of pocket costs
‣ Determine primary payer
MSP Questionnaire
Every admission
Every outpatient encounter
Every start of care
Retained for 10 years
Recurring services – verify information every 90 days
Update COBC when information does not match CWF record
Contact the COBC to report
Employment or other insurance coverage changes
Liability, auto/no-fault, or workers compensation case
Providers may fax or mail proof of information on the insurer’s or companies letterhead
Beneficiary may call to change existing information
Updated 02/05/2013 1
http://www.wpsmedicare.com/

When to Use Condition Code (CC) 08
‣ Beneficiary actively refuses to provide other insurance information
Beneficiary cannot choose what insurance pays for services
MSP regulations must be followed regardless of who the responsible party may be
Code claim with CC 08
Bill Medicare as primary
Contractor will develop claims to determine responsibility
Checking diagnosis(s) against MSP information on CWF
Claim may become beneficiary liable
When Not to Use Condition Code (CC) 08
‣ Do not use CC 08 if beneficiary is unconscious, or otherwise incapable of giving other insurance
information
Check CWF/C-SNAP/IVR for primary insurance information
Contact family or guardian
Document all attempts to obtain primary insurance information in remarks
Send claim as Medicare primary
If codes indicate an injury or accident, Medicare Secondary Payer Recovery Contractor (MSPRC)
will investigate
Coding MSP Claims
‣ Condition Codes
Develop the circumstances surrounding claim
‣ Occurrence Codes
What happened when
When to use 05 OC
‣ Occurrence Span Codes
Span of dates indicating what happened when
‣ Value Codes
This program is presented for informational purposes only. Current Medicare regulations will always prevail.
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Who paid what
Contractual amount
‣ Remarks
Information regarding claim that cannot be documented elsewhere
References
‣ CMS Internet-Only Manual (IOM), Publication 100-05, Medicare Secondary Payer Manual, Chapter 3
http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/msp105c03.pdf
‣ WPS Medicare Website, J5 Medicare Secondary Payer Page
http://www.wpsmedicare.com/j5macparta/departments/secondary_payer/index.shtml
‣ WPS Medicare Website, J8 Medicare Secondary Payer Page
http://www.wpsmedicare.com/j8macparta/departments/secondary_payer/index.shtml
Acronyms
‣ CC – Condition code
‣ COBC – Coordination of Benefits Contractor
‣ C-SNAP – CMS Secure Network Access Portal
‣ CWF – Common Working File
‣ IVR – Interactive Voice Response Unit
‣ MSP – Medicare Secondary Payer
‣ MSPRC – Medicare Secondary Payer Recovery Contractor
‣ OC – Occurrence Code
This program is presented for informational purposes only. Current Medicare regulations will always prevail.
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