4 – None
Awaiting final system purge. <>/Metadata 1240 0 R/ViewerPreferences 1241 0 R>>
Blood Deductible Pints – The number of blood deductible pints remaining to be met for the benefit period. The ending date of a beneficiary's election period. The ICD-9-CM Code Inquiry screen (Map 1731) appears: To make an additional inquiry, type the new diagnosis code over the previously entered diagnosis code and press. You may need to use your F5 and F6 keys to scroll through the entire list of claims to find the beneficiary's claim you want to adjust. For institutional outpatient claims with advanced diagnostic imaging services subject to the Appropriate Use Criteria (AUC). To move to another revenue code, press F6 to scroll down and F5 to scroll up. related listings are included in CDT-4. The termination date for the rate listed (MMDDYY format). Original User Action Code. Identifies the ending date of service. Note: If the beneficiary's name is John Smith Jr., enter "SMITHJ". Review the information under the heading "Information about the APP DATE Field" found earlier to ensure you review data that may impact your dates of service. 2 – services not paid under OPPS (status indicator A)
The apportioned line level outlier amount returned from the MSP module. The CMS Medicare Program Integrity Manual, Pub. This will only occur in rare situations such as a claim requiring development external to the intermediary's operation (PIP). Z01.419) will be denied as a provider write-off. P – open biopsy changed to closed biopsy
Also refer to MLN article, SE1249. Y – the documentation supporting the medical necessity was received. Effective date. The first Initial of the beneficiary name. The Roster Bill screen allows entry of up to 10 beneficiaries; however, only four beneficiaries can be entered on the first screen. The original paid claim will remain in FISS. The accumulated amount by adding the Federal Regional Totals and the Federal National Totals. The ESRD method of reimbursement (Method 1 or Method 2). This field is used to make a selection to view information for a particular adjustment reason code. 9/1/2021. The sequence record number of the paid claims starting with 00 and occurs up to 16 times. Date of Latest Billing Action (DOLBA). Select the claim from your RTP list on the Claim Summary Inquiry screen (Map 1741). The Claim and Attachments Entry Menu screen (Map 1703) appears: From the Claim and Attachments Entry Menu (Map 1703), enter the appropriate claims entry option in the, When Page 01 of the claim appears, FISS automatically inserts default information into the type of bill (. One position numeric field. website, click here
Values are: Override code. G0101-AR, 1 Look up: Screening, Cervical, and Clinical Breast Exam, AR modifier assigned for rural underserved area, 1 unit only. Up to three professional component dates may be displayed. HCPCS codes for subsequent hospital care services, with the limitation of 1 telehealth visit every 3 days. Identifies the Document Control Number assigned to the claim. If the original claim information did not post to the Common Working File (CWF), the claim cannot be adjusted. PCA-1-21-01821-M&R-FAQ_06012021 ... in addition to the IPPE, you may also bill CPT ... these codes includes reimbursement for all services listed. When this field is left blank, the following eligibility information, if applicable, will display data based on the current date. This will help to limit the number of claims that are viewable in your RTP file, and will assist you in avoiding duplicate claim submission errors. Not used by home health or hospice providers. Corrected Medicare ID number. The top line of information is carried over from the ELGA screen page 01. This is a four-position field. upon notice if you violate its terms. Valid values are:
The PROV PRACTICE ADDR QUER screen (MAP1AB1) appears. HCPCS Type. The following information will display on the screen under RETURNED FROM GROUPER or RETURNED FROM PRICER. Allowable revenue codes. Additional pages, beyond page 22, will display if more than one MSP record exists. The "Attachment Entry" options are not accepted electronically via FISS DDE. These claims can be accessed by selecting 12 (Claims) from the Inquiry Menu; typing your NPI in the NPI field, and entering the beneficiary's Medicare number in the MID field. The total charge submitted on the CMS-1450 claim form. The last billed date of the beneficiary's effective period with the Hospice provider. Follow the steps below: If the claim is partially noncovered/denied the reason code in the lower left corner may not explain why a specific revenue code line was denied. In addition, the CAN DT of the original claim will match the PD DT of the adjusted (817) claim. S Claim Status
Claim type. The valid values are: Quantity – This field identifies the number of services billed for each date. 2 – Additional information required – missing/invalid/incomplete data from submitted claim
You may choose to submit documentation electronically. The low-volume payment amount calculated by the IPPS PRICER. The blended accumulated amount total by adding the Federal Regional Totals and the Federal National Totals. Claim Adjustment Reason Code (CARC) shown on the primary payer's remittance advice. (MMDDCCYY). Valid values are: Generate hardcopy. 7 Physical therapy service, do not pay the HPSA bonus
For intermediary use only. Refer to the Inquiry Menu in this User Manual for additional information. This date instructs the system to either use the "from" date of the claim or the system run date to perform edits for this revenue code. Cancel date. The SNF coinsurance days remaining in the current benefit period. Refer to the Inquiry Menu section of this guide for information about option 56. You can use the PLAN-ID code to look up contact information for the MA plan by accessing the MA Plan directory. Do not use your, If you attempt to type in an invalid field position, your keyboard will lock. The intermediary number for the earliest hospital bill processed with a deductible. CPT Assistant guidelines state that a pelvic and breast exam, and a screening Pap smear, are all part of the comprehensive preventive service and should not be reported separately. 02 – Able to bathe in shower or tube with the intermittent assistance of another person. 99 – No iQIES Assessment found, This field indicates Current Ability to Dress Upper Body safely (with or without dressing aids) including undergarments, pullovers, front-opening shirts and blouses, managing zippers, buttons, and snaps. B – ESRD beneficiary in a 30-month coordination period with an employer group health plan
A – home health only – not intermittent care – technical and waiver was applied
P – Pricer upcode/downcode; The Pricer program in FISS changes the HIPPS code to "early" or "late" based on the beneficiary's adjacent episode history posted to the Common Working File (CWF) and/or the claim contains more or less therapy revenue codes than indicated by the HIPPS code submitted. The claim types identified for each adjustment reason code. The example below is a home health claim/cancel. This option includes several screen pages with eligibility information. Blood Deductible Pints – The number of blood deductible pints remaining for the benefit period. 06 – Unable to participate effectively in bathing and is bathed totally by another person. To search for a beneficiary's claims for specific dates of service and specific type of bill, type your facility's NPI, the beneficiary's Medicare number, the type of bill, and the "from" and "to" dates. However, if the beneficiary has supplemental insurance, key the insured's supplemental insurance information on Line B. This field follows the ICD diagnosis code field and identifies the Present On Admission (POA) indicator for every principal and secondary diagnosis and whether the patient's condition is present at the time the order for inpatient admission to a general acute care hospital occurs. Continue to work through the reason codes, one at a time, until you are returned to Map 1741 and the claim is eliminated from your claim correction list. Federal Tax Number (subsidiary) (do not enter). This field indicates whether a rate must be entered for this revenue code. Records are stored based on the location where the beneficiary's Social Security Number was issued. The first Zip Code on the Zip Code file displays first. F8 – Move one page forward. Ensure that all required fields are complete. Font Size:
In addition to entering your NPI, a Medicare number and S/LOC, you can enter data in the TOB (type of bill), FROM DATE, and TO DATE fields (circled and bolded below) to further narrow your search. The full skilled nursing facility (SNF) days remaining in the current benefit period. This identifies whether the beneficiary has received a Medicare covered transplant. Hardcopy/Quality Improvement Organization (QIO) Status/Location. Number of coinsurance days used. L – full provider liability – code changed to reflect actual service
DO NOT ACCEPT" AND EXIT FROM THIS COMPUTER SCREEN. abide by the terms of this agreement. If the Medicare number has changed, this field represents the most recent number. The first billed date of the beneficiary's effective period with the Hospice provider. 5/20/2021. More than one reason code may appear in the lower left-hand corner of Page 01 of the claim. 5 – set systematically from the reason code file to identify claims for which special processing is required
The Base Operating DRG Payment Amount. The ANSI code within the above record type. All four claims are type of bill (TOB) 32X (CAT code 32). Next eligible technical date for bone density testing. You may also access this screen by typing 1C in the SC field and pressing Enter, if you are in an inquiry or claim entry screen. Paid date. This is a one-position alphanumeric field. Page 07 also identifies the address to which your documentation can be mailed. Claim adjustment standard reason code identifying the reason for the adjustment. Y MSP cost avoided, Fee Indicator. F7 – Move one claim page back
You should correct the reason codes one at a time. 03 – Able to participate in bathing self in shower or tub, but requires presence of another person throughout the bath for assistance or supervision. Identifies the amount entered by the provider (if available) or apportioned by FISS as payment from the primary payer. Identifies the date for which the CARC/RARC/GROUP combination were added. PCA-1-21-01821-M&R-FAQ_06012021 ... in addition to the IPPE, you may also bill CPT ... these codes includes reimbursement for all services listed. Taxonomy code. If the beneficiary's information cannot be found at the default host site, you may need to look for the beneficiary's information at another host site by entering a two-character HOST-ID site (e.g., SO). Total cost sharing amount for HCPCS G2068 – G2088. Identifies the medical review suspense codes when a claim is edited based on the medical policy parameter file. The HCPCS code to be reviewed on the screen. Identifies the last operator who created or revised this screen and the date. Professional service rate. When the last digit shows an "X," each variable for that revenue code is allowable. Some private insurers will reimburse for obtaining a screening Pap smear using code Q0091 on the day of a preventive medicine service. 0 – Unchecked (No)
Note: This screen should not be used to determine a beneficiary's status in a home health episode. Valid values:
The group number for the policyholder with this insurer name. Data Indicators – This field identifies the data indicator. This field identifies whether a December inpatient stay has been applied to the current year deductible. Overrides the way the OCE module controls the line item. The accumulated FSP and HSP total amount for Operating Payments. To review a particular adjustment reason code, enter the adjustment reason code value in this field. Please make sure that you want to suppress the view of the claim before following the steps below. CARC codes explain the difference between the billed amount and the amount paid by the primary payer. This field indicates Bathing: Current ability to wash entire body safely. If none of these options work, and you have consulted with your technical support department with no resolution, please contact your connectivity vendor. Place your cursor anywhere on the revenue code line 5. Sometimes, new codes will appear. Complex Manual Medical Review Indicator. The valid codes are: The home dialysis method selection effective date. TC – Total count of claims in a particular status/location. The month and day of the "through" date of the claim. 5 Rural health clinic or comprehensive outpatient rehabilitation facility psychiatric
Press ENTER. The carrier number assigned to your provider file. The Fiscal Intermediary Standard System (FISS) Claims/Attachments option (FISS Main Menu option 02) allows you to enter the following billing transactions via Direct Data Entry or DDE: Tab – Moves your cursor from left to right, placing it in a valid field
National Coverage Determination Override Indicator. This screen also provides information to verify what additional information (e.g., units, HCPCS code) must accompany the revenue code. Valid Values:
The number of Lifetime Reserve Days used during this benefit period.
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