Handling Charges by C3PEDF9

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									COLUMBIA/HCA
DEPARTMENT: Governmental Operations                   POLICY DESCRIPTION: BILLING - Handling
 Support / Billing Compliance Support                 Charges
PAGE: 1 of 2                                          REPLACES POLICY DATED: Jan. 16, 1998
APPROVED: February 25, 1999                           RETIRED:
EFFECTIVE DATE: March 1, 1999                         REFERENCE NUMBER: GOS.LAB.005

SCOPE: All Company facilities performing and/or billing laboratory services. Specifically, the
following departments:

             Business Office                  Nursing
             Admitting                        Laboratory
             Finance                          Health Information Management
             Administration                   Utilization Review
             Revenue Integrity

PURPOSE: Carriers and Fiscal Intermediaries will not make payment for routine handling charges
when a specimen is referred from one laboratory to another. The cost associated with preparing a
specimen for transfer is considered a integral part of the testing process and such services are included
in the total charge.

POLICY: Specimen handling charges must not be billed to Medicare, Medicaid, or other federally
funded programs.

PROCEDURE: The following steps must be performed to ensure that handling charges are not billed
to federally funded programs.

IMPLEMENTATION

1. Laboratory personnel must review and ensure applicable revisions are made to the chargemaster
   and related Laboratory and Order Entry masterfiles/dictionaries as follows:

        a. Assign CPT /HCPC codes as defined below and attach revenue code 300 in accordance with
           the UB-92 Manual for handling charges.

        99000- Handling and / or conveyance of specimen for transfer from the physician’s office to a
        laboratory.
        99001- Handling and / or conveyance of specimen for transfer from the patient in other than a
        physician’s office to a laboratory (distance may be indicated.)
        99002- Handling, conveyance, and / or any other service in connection with the implementation
        of an order involving devices (e.g., designing, fitting, packaging, handling, delivery, or mailing)
        when devices such as orthotics, protectives, prosthetics, are fabricated by an outside laboratory
        or shop but which items have been designed, and are to be fitted and adjusted by the attending
        physician.




03/01/1999
COLUMBIA/HCA
DEPARTMENT: Governmental Operations                    POLICY DESCRIPTION: BILLING - Handling
 Support / Billing Compliance Support                  Charges
PAGE: 2 of 2                                           REPLACES POLICY DATED: Jan. 16, 1998
APPROVED: February 25, 1999                            RETIRED:
EFFECTIVE DATE: March 1, 1999                          REFERENCE NUMBER: GOS.LAB.005

2. Business office personnel must establish edits in the electronic billing system which prevent billing
   handling charges to federally funded programs.

3. Laboratory and business office personnel must educate all staff associates responsible for ordering,
   Charging, or billing laboratory services on the contents of this policy.

4. The Facility Billing Compliance Committee must perform periodic audits as outlined below:

            If services related to handling charges are not billed to any payor, review the chargemaster
             to ensure handling charges as defined in this policy are not present. Document your
             findings on the Billing Audit Action Worksheet, Policy Reference Number GOS.GEN.001.
            If services related to handling charges are billed to non-federally funded payors complete
             the attached Audit Worksheet monthly in accordance with the Billing – Audit & Monitoring
             Policy, Reference Number GOS.GEN.

5. Business office personnel must identify intermediary interpretations which vary from the
   interpretations in this policy. Specific intermediary documentation related to the variance(s) must
   be obtained and faxed to 615-344-2734, Attn: Billing Compliance - Intermediary Interpretations.

DAILY
1. Business office personnel must review electronic billing edit / error reports daily and perform the
   following:

       a. Eliminate handling charges for all federally funded payors.
       b. Modify number of units and related charges in the electronic billing vendor system to reflect
          the appropriate charge.
       c. Modify number of units and related charges in the Accounts Receivable system to match the
          corrected claim in electronic billing system. (Note: Utilize ancillary charge codes rather than
          correcting claims with adjustment codes. Corrections made subsequent to final bill should be
          processed through your patient accounting system late charge cycles.)

It is the responsibility of the Chief Financial Officer to ensure adherence to this procedure.

REFERENCES:
Medicare Carriers Manual, Section 5114.1.D as revised by Trans. 1442 Dec. 1992.
Medicare Hospital Manual (HCFA- Pub. 10) §437
CCH, Medicare Medicaid Guide 3330.82, Specimen Collection Fees (1997)




03/01/1999
Audit Sheet Instructions: Handling Charges
Policy Reference Number: GOS.LAB.005

Select a random sample of at least 15 outpatient accounts (or 100%, which ever is less) in which laboratory
services were provided by a reference laboratory.

Obtain the following documents for each patient account selected and perform the self-audit function.

     The documentation/forms such, as the Lab Requisition form, Encounter form, Physician Order form, etc.
      which is used to document orders.
     UB 92 and Detail Bill generated from the Accounts Receivable System.
     Billing documents generated from the Electronic Billing System.
     Remittance Advice and/or billing details from the applicable Medicare On-line system.

The Billing documents from the A/R system, Electronic Billing System and Remittance Advice and/or Medicare
On-line system need to be utilized to complete the Audit Worksheet to help ensure the following:

     Review of the billing documents from the A/R system will help identify and address underlying process and
      / or masterfile/dictionary issues in the Order Entry, Laboratory or A/R systems to the fullest extent possible
      within system limitations. For those instances in which the current Order Entry, Laboratory or A/R systems
      will not produce a compliant bill, Electronic Billing System edits will be established to edit the claims and
      provide a tool to make appropriate corrections.
     Electronic Billing system edits will be properly established in accordance with the applicable billing policies
      and corrections to billing data made in both the Electronic Billing system and the Accounts Receivable
      system. This will help ensure a compliant bill is properly submitted as well as proper updates to the A/R
      systems to ensure accurate A/R valuation, logs, patient statements, billings to secondary payors, etc.
     Detail billing data on the Remittance Advice and/or billing details from the Medicare On-line system will be
      reviewed to ensure inappropriate changes were not made to the claim on the Medicare On-line system.

Complete each field on the Audit Worksheet as follows:

            Complete (D) - (H) using the UB92 and Detail Bill from the A/R system
            and ordering documentation as necessary.

(A) - (C) Complete the Account #, Financial Class, Patient Name and Date of Service
          fields for the federally funded payors.

(D) - (F) If CPT 99000, 99001, and/or 99002 are present on the account indicate "Y"
          (yes). If these CPTs are not present on the account indicate "N" (no).
          Document specific issues including underlying process and/or
          masterfile/dictionary issues in the Comments Column.

(G)         If any CPTs present on the account were billed with a Revenue Code other
            than 30X, indicate "Y" (yes). If all CPTs present on the account were billed
            with 30X indicate "N" (no).

(H)         If (G) was answered "Y" indicating CPT(s) were present on the account with
            a Revenue Code other than 30X, enter the applicable procedure code/billing
            code #, CPT and Revenue Code for the procedure. Document specific issues
                                                                                           Attachment to GOS.LAB.005
Audit Sheet Instructions: Handling Charges
Policy Reference Number: GOS.LAB.005

          including underlying process and/or masterfile/dictionary issues in the
          Comments Column.


          Complete (I) - (K) using billing documents from the EP Vendor, RA
          and/or On-line Medicare system and ordering documentation as
          necessary.

(I)       Review the billing documents from the EP Billing Vendor and determine if
          the actual bill submitted was in accordance with policy after edits/translations
          were performed on the bill from the A/R system. If the submitted bill was not
          in accordance with policy indicate "Y" (yes). If the submitted bill was in
          accordance with policy indicate "N" (no). Document specific issues including
          underlying process and/or masterfile/dictionary issues in the Comments
          Column.

(J)       Compare the billing documents from the EP Billing Vendor system to the
          UB92 and Detail Bill from the A/R System and determine if all edits
          performed on the EP Vendor were corrected in the A/R system. If corrections
          were not made on the A/R system, indicate “Y” (yes). If corrections were
          made on the A/R system, indicate “N” (no). Document specific issues
          including underlying process and/or masterfile/dictionary issues in the
          Comments Column.

(K)       Compare the billing documents from the EP Billing Vendor system to the
          Medicare On-line system or the Remittance Advice to determine if any
          inappropriate changes were made to the claim on the Medicare On-line
          system. If variances exist indicate “Y” (yes). If variances do not exist
          indicate “N” (no).

(L)       Enter specific comments related to special circumstances or exceptions with
          each account.

(M)       Enter the total number of applicable accounts reviewed (e.g. exclude the
          N/As).

(N)       Enter the total number of accounts for which (I) - (K) were answered "Y".

(O)       Calculate the % Error Rate by dividing (N) by (M).


Log the overall error rates, issues and actions to be taken on the Laboratory Action Worksheet in accordance
with the “Billing - Auditing Procedures” Policy, Reference # GOS.GEN.001.




                                                                                        Attachment to GOS.LAB.005

								
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