Compensate FAQ
Instruction Paying Anesthesia Fee Bills
Anesthesia can be billed on CMS form UB04 and is processed the same as any other Inpatient or Outpatient line item by utilizing the Cost To Charge process and its appropriate modifiers of either 11 or 13. Anesthesia can also be billed on a CMS form 1500 and the process for paying is a follows:
An anesthesia bill contains two
components
1.
ABU’s
or anesthesia base units
2.
The
actual timed minutes used during the procedure.
Note: if time units are not shown on the fee
bill, contact the provider
In the case of CPT 00400 in which the actual minutes used was 1 hour CPT 00400 has Three ABUs (15 minutes
per ABU) = 45 minutes
One hour of anesthesia timed service =
60 minutes (one minute per unit)
For a total number of minutes = 105
minutes x The BWC rate of $2.88133 per minute = $302.54 reimbursed.
Fill in the Compensate® CPT payment screen as you would normally up to the point where you would enter the fee bill amount.
The final result is as below and may or may not agree with the fee bill depending on whether or not the provider included the ABU values on the in the bill.
(see rules section below) Compensate® calculates the fee bill using the BWC base units table and the timed minutes from the fee bill. The payer is responsible to determine the final payment amount. (See rules section below)
Rules Section Anesthesia Billing Clarification March 5, 2012 With the implementation of the 837 5010 version in the health-care industry, covered entities under the Health Insurance Portability and Accountability Act now must report anesthesia care in one-minute increments as opposed to the previous 15-minute units. The correct way for a provider to submit a bill to BWC is to report the Medicare anesthesia base unit (ABU) in minutes added to the timed anesthesia services. As noted in Chapter 3 of the Billing and Reimbursement Manual, it is the provider’s responsibility to calculate the total number of anesthesia minutes when submitting a CMS 1500 for payment. BWC will use the sum of the minutes of the ABU and the timed care to determine reimbursement. The bill for anesthesia services must reflect total minutes in the Units column (24G) of the CMS 1500. EXAMPLE: Three ABUs (15 minutes per ABU) = 45 minutes + 60 minutes (one hour of anesthesia timed service per one minute per unit) = 105 minutes x $2.83133 = $302.54 reimbursed. BWC’s system prices at a current rate of $2.83133 per unit for dates of service from Jan. 1, 2012 and beyond. You can find service reimbursement information in the preamble of the current Professional Provider Medical Services Fee Schedule per the link below. http://www.ohiobwc.com/provider/services/FeeSchedules.asp Provider e-News October 2012 Anesthesia base units Effective Jan. 1, 2013, anesthesia providers will no longer be required to submit the Medicare Designated anesthesia base units (ABUs) in addition to the timed anesthesia service on their Center for Medicare and Medicaid Services (CMS) 1500. The ABUs are adopted as part of the Medical Services and Professional Provider Fee Schedule. The managed care organizations will be adding the ABUs to the encounter and submitting that information to BWC for provider anesthesia-care reimbursement. For more information, email fee schedule questions to the Medical Services Division. |
eDocs Setup / Installation
Some eDoc configurations use the SQL server FILESTREAM option. This option is required when there are remote users that need to add or have access to the stored documents. Below are some links for system administrators that layout the best practices for implementing FILESTREAM on the server. Server Commands for the filesystem FSUTIL BEHAVIOR SET DISABLE8DOT3 1 FSUTIL BEHAVIOR SET DISABLELASTACCESS 1 Also All Anti-Virus scanning needs to be disabled for the FILESTREAM Folders Workstation Configuration When using the FILESTREAM option for eDocs it is required that all workstations be upgraded to the latest SQL Server Drivers. SQL driver versions can be verified on the workstation by looking at the drivers tab on the Control Panel --> Administrator Tools --> Data Sources (ODBC) applet. Either SQL Server Native Client 10.0 or 11.0 have been tested and will work with eDocs. If the workstation does not have these driver updates they can be found under the Compensate application folder under dll_source\sql. When installing the drivers be sure to use the correct version (x86 or x64) for the operating system installed. Failure to have the updated drivers installed will cause the application on the workstation to fail to connect to the SQL server. |
EDI Release 3 - Common Problems
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Positive Pay File Setup Requirements
Each bank has their own file formatting requirements for their ACH / Positive Pay files. Below are some of the setup requirements by bank. All of these settings are entered into the Risk Information --> Checking Account screen for the specific risk. 5th 3rd Bank
First Midwest Bank
Huntington Bank
JP Morgan Chase
Key Bank
National City
PNC Bank - Pinacle
PNC Bank
Single Point - USB
US Bank
Wells Fargo
WesBanco
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Line Item Method for Processing UB92 / UB04 Hospital Outpatient Fee Bills
The new Hospital Outpatient Reimbursement Rule of 4/1/2012 OAC 4123-6-37.2 A (b) (ii and iii). http://www.ohiobwc.com/downloads/blankpdf/HospOutReimburseRuleApril12.pdf now requires that all outpatient fee bills using forms UB92 / UB04 be reduced by line item in order to reimburse the correct amount. It is no longer acceptable to simply reduce the entire bill using the cost to charge ratio. The following bill types are subject to the line item procedure. 131, 132, 133, 134, 135 (found in box 4 on the UB-04) Hospital outpatient fee bills after 4/1/2012 will contain line items that are reduced by a fee maximum schedule (found in Appendix A of this rule), or by reasonable cost (cost to charge percentage). Some line items that are Not Routinely Covered have a fee maximum amount. To properly reduce these bills the following procedure applies: Outpatient bills must be reduced by line item using the CPT Payment program in Compensate®The first thing you will need is the 11 digit BWC Provider number which is located in box 51 on the UB92 and box 57 on the UB04. Do not use the 9 digit Tax number from box 5. In some cases the box 51 value is only 9 digits long instead of 11. If you use the 9 digit number the default cost to charge percentage will be 56%. Avoid overpayment by using the correct BWC provider number. Enter the 11 digit BWC Provider ID and select the appropriate payment address. Input the Patient ID from the fee bill. Input the billing date, Service From and To dates. Use place of service code 22 for all outpatient bills. Enter the CPT code and use modifier 13 for all line items. If there is no CPT code listed - such as for "medical supplies" - you may choose to request an itemized bill from the provider or use a general code. The use of general codes such as W9999 will allow the reduction of items on the bill that do not have CPT codes. Using this code, the fee bill amount will always be reduced by the proper cost to charge percentage. The procedure description can be edited when using a general code Enter the fee bill amount and the adjusted fee maximum will show the reduced amount based on the line item instructions in the BWC fee schedule. Some items will result in a payment value of 0.00 because the CPT code is never allowed and a message on screen will indicate Never Covered. Some items will display a dollar amount but the on screen message will indicate that the CPT code is Not Routinely Covered but if you decide to pay anyway there is an associated fee maximum amount. Repeat the above until all line items have been processed. Make sure you use modifier 13 on every line item… other modifiers will give much different results. |
Which Check Stock to I use?
http://www.greatland.com part numbers that are compatible with Compensate are: Classic Security LSR501MB14 MARBLE BLUE LSR501BB14 HERRINGBONE BLUE Premier Security 80751 PRISMATIC CUBE
BLUE\GREEN |
Hardware / System Minimum Requirements - All Applications
Server Minimum Requirements
Workstation Minimum Requirements
Support Minimum Requirements
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Install Compensate Client - SI and State Fund
To install the Compensate client on a workstation !Note: "application" refers to the folder where Compensate is installed on the server.
Security Considerations
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Un-Void Medical, Expense, Indemnity Transactions
To un-void a transaction that has been previously voided - you need to "Void the Void Transaction"
Note: This has the potential to change reports that have been distributed prior to the date the transaction is being un-voided. There is no history kept on how many times a transaction was voided and unvoided.
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Claim / HRMS Screen Right Click
![]() Right Clicking on the Claim screen or the HRMS Employee Data Screen will bring up a pop up menu that allows the user to quickly copy contact information for the claimant to the Windows Clipboard. After the data has been copied to the clipboard it can be pasted anywhere else in windows including your favorite label printing or word processing application. This pop up menu also will open Google Maps for the claimant's home address where driving directions can be found. |