In the case of CPT 00400 in which the actual minutes used was 1 hour

Fill in the Compensate® CPT payment screen as you would normally up to the point where you would enter the fee bill amount.  

When you enter the fee bill amount a pop up window will appear asking you to enter the beginning and ending time values from the fee bill.   The time values must be in 24hr clock For example 1:30 in the afternoon is entered as 1330, 12:30am is entered as 1230

(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

• Do not file a late reason on reports unless the jurisdiction requests it.  The state of West Virginia rejects all reports (TR) with late reason codes and will not look at the rest of the report, the report may be correct but will not process solely based on the late reason code which only delays the report further.
• All reports that receive a TE acceptance value (accepted with errors) must be refiled using a CO (correction) report after repairing the problem with the report.  The jurisdiction will not accept any more reports until they receive a CO and they accept it with a TA value.  To file a CO report - Right click on the report that received the TE acceptance value in the FROI or SROI history screen.  The claim values that are missing or incorrect must be repaired and a CO report must be filed on the day that the results are loaded so there will be no delay in future reports.
• If the last report that was filed is a AQ report (Acquired Claim) the next report that must be filed is an AP (Acquired Payment) report.  All other reports will be rejected until the AP report is accepted.  The AP report only needs to include the 440 (Total Prior Unallocated Medical Benefits) and the 430  (Total Prior Unallocated Indemnity Benefits) segments under the "Other Benefits" tab.
• When acquiring a new company a AQ FROI report followed by a AP SROI report must be filed for each open and active claim.  After the AQ and AP reports are accepted any other report can be filed for the claim. All other reports will be rejected until the AQ and AP reports are accepted.
• When changing the claim administrator information a 02 FROI and 02 SROI report must be filed for each open and active claim.  After the 02 reports are accepted any other report can be filed for the claim.  All other reports will be rejected until the 02 reports are accepted.  
• All companies in a specific database must share a common claims administrator and EDI trading partner.

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:

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.  

http://www.greatland.com part numbers that are compatible with Compensate are:

Classic Security

LSR501MB14                       MARBLE BLUE
LSR501MBG14                    MARBLE BURGUNDY
LSR501MG14                        MARBLE GREEN
LSR501MY14                        MARBLE YELLOW

LSR501BB14             HERRINGBONE BLUE
LSR501BG14             HERRINGBONE BURGUNDY  
LSR501GN14             HERRINGBONE GREEN
LSR501GR14             HERRINGBONE GREY
LSR501T14                HERRINGBONE TAN

Premier Security

80751                          PRISMATIC CUBE BLUE\GREEN
80774                          PRISMATIC CUBE BLUE\BURGANDY 

Server Minimum Requirements

• Windows 2008 R2 Server x64
  • IIS 7 with Microsoft .Net Framework 2, 3, 3.5 and 4.0 required for Compensate Web Reporter
• Microsoft SQL Server 2008 R2 Standard Edition x64
  • SQL Server 2008 R2 with Reporting Services installed
• Hardware - to be specified by MS SQL Server requirements - minimum specification below
  • Intel i7 or greater processor
  • 8 Gb RAM or greater
  • 500 Gb (RAID 5) storage minimum - much much more if using Compensate eDocs - document storage
• Compensate is compatible with all Microsoft Terminal Services and Citrix remote access solutions

Workstation Minimum Requirements 

• Hardware requirements to be specified by Microsoft Windows and Microsoft Office a general minimums list is provided below.
• Intel i5 or i7 class processor
• Operating System
  • Microsoft Windows 2008, Windows 7, Windows 8
• 4 Gb RAM
• Microsoft Internet Explorer 9.0 or later
• 10 Gb Hard disk space required for application - user data extra and site dependent
• Display
  • 1024x768 resolution minimum
  • 256 colors minimum (high color recommended)
• Printing
  • Windows compatible printer with magnetic toner ability (if printing checks)
  • Laser Printing required – No inkjet technology (if printing checks)
  • Multiple paper trays recommended.
• Microsoft Office 2010
  • Microsoft Word for form letters
  • Microsoft Excel for Ad-Hoc Reporting and Graphing
  • Microsoft Outlook for Task Lists and E-mail reports
• Adobe Acrobat 10.1 Reader or greater.  A standard version if Adobe Acrobat is recommended for clients using eDocs to aid in merging and exporting document files.

Support Minimum Requirements

• Remote connectivity required for upgrades and support services this can be any of the following:
  • PC Anywhere v10 or greater
  • Windows Remote Desktop
  • Windows Terminal Services
  • Citrix
  • Win VNC