Compensate FAQ

Instruction Paying Anesthesia Fee Bills

posted Apr 24, 2013, 6:07 AM by Compensate Admin   [ updated Apr 24, 2013, 7:12 AM ]

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.  



   
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

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

posted Jan 28, 2013, 7:53 AM by Compensate Admin   [ updated Feb 8, 2013, 8:05 AM ]

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

posted Dec 27, 2012, 6:15 AM by Compensate Admin   [ updated Dec 27, 2012, 6:31 AM ]

  • 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.

Positive Pay File Setup Requirements

posted Dec 20, 2012, 5:27 AM by Compensate Admin   [ updated Apr 1, 2016, 6:37 AM ]

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
  • The file name for the positive pay file must be placed in the LOGDX field.
  • The three digit bank number must be placed in the ARPID field - this will be specified by 5th 3rd - value might be 052
Bank One
  • Login Header string supplied by the bank must be placed in the LOGDX field
  • ARPID will be supplied by the bank and is also included as part of the file name. 
Bank of America / Bank of America - PAYEE
  • No Special Settings
First Midwest Bank
  • The file name for the positive pay file must be placed in the LOGDX field.
  • The three digit bank number must be placed in the ARPID field - this will be specified by the bank - value might be 642
First National Bank
  • ARPID needs a 3 character value that will be supplied by the bank and will be included in the file name
Huntington Bank
  • Huntington requires a specific file name for the files to be uploaded.  The file name must be entered in the LOGDX field.
JP Morgan Chase
  • ARPID will be supplied by the bank and is also included as part of the file name. 
  • Chase is requiring signed and encrypted files.  Compensate generates the text file required for Chase but can not sign the file because the file must be singed with a PGP key that is generated for the exclusive use of the client that owns the checking account. Users will have to download and install GPG4win (http://www.gpg4win.org) to sign and encrypt the file as required by Chase. 
  • Chase has 2 file formats - Direct and Web to get the Web format set the ARPTYPE to WEB. If ARPTYPE is empty the direct file format will be generated.
Key Bank
  • No additional information is needed from the bank.  The file is complete as generated.
National City
  • ARPID (8 characters) and ARPTYPE (5 characters) values will be supplied by the bank
  • ARPTYPE value of ARPDB will generate a file with a column with of 200 characters otherwise it generates a file with a record length of 80.
PNC Bank - Pinacle
  • PNC requires a specific file name for the files to be uploaded.  The file name must be entered in the LOGDX field.
PNC Bank
  • PNC requires a specific file name for the files to be uploaded.  The file name must be entered in the LOGDX field.
Single Point - USB
  • No special configuration
US Bank
  • No special configuration
Wells Fargo
  • There are 3 file formats for Wells Fargo 
    • Old file format requires a Login Header string supplied by the bank must be placed in the LOGDX field
    • National file format requires the string "NATIONAL" in the LOGDX field
    • The new file format requires the LOGDX field to be blank and the 5 digit bank number to be placed in the ARPTYPE field.
  • If there are values in the ARPTYPE and LOGDX fields the old file format will be generated
  • ARPID will be supplied by the bank and is also included as part of the file name. 
Westbanco
  • Westbanco requires a specific file name for the files to be uploaded.  The file name must be entered in the LOGDX field.

Line Item Method for Processing UB92 / UB04 Hospital Outpatient Fee Bills

posted Apr 12, 2012, 7:24 AM by Compensate Admin

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?

posted Dec 2, 2011, 12:03 PM by Compensate Admin   [ updated Dec 2, 2011, 12:06 PM ]

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 


Hardware / System Minimum Requirements - All Applications

posted Nov 29, 2011, 9:48 AM by Compensate Admin   [ updated Sep 14, 2017, 11:55 AM ]

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 

Install Compensate Client - SI and State Fund

posted Mar 11, 2011, 9:01 AM by Compensate Admin   [ updated Sep 12, 2017, 11:17 AM ]

To install the Compensate client on a workstation

!Note: "application" refers to the folder where Compensate is installed on the server.
  1. From the application\dll_source folder run setup59_cr.exe to install the application *.dll files on the workstation
    1. There may be an error 1501 - registering a font - this can be safely ignored
  2. From the application\dll_source folder run SshActiveX-9.3.1-win32.msi, this is for the SFTP client for CMS reporting
  3. For workstations that are going to print checks install the MICR.TTF font found in the application\exports folder
  4. Create the printer with the name "Compensate PS" so the workstation can e-mail reports (instructions can be found here)
  5. If the OS on the workstation is Windows 7 or greater, run the fix windows7.cmd file in the application folder.
    1. This script may need to be edited for non-standard windows installation folders or if running Windows x64.  
    2. There are comments in the script regarding x64 installations.  
  6. Install the SQL Native Client v10.0 on the workstation the source for this installation can be found in the application\dll_source\sql folder.  The file name is sqlncli-x86.msi or sqlncli-x64.msi
  7. Create a shortcut for the application being installed from the application folder - all of the steps above only installed the DLL files required to run the application - the actual application is installed on the server.
Security Considerations
  1. The user account must have read, write and modify permissions on the application folder and the eDocs storage area.
  2. The user account must have dbo permissions on the appropriate database to the SQL server where the database is stored.
  3. Application permissions and database permissions are best managed through the use of  Active Directory groups instead of explicit permissions granted per user.
  4. Setup59_cr.exe and SshActiveX-9.3.1-win32.msi must be installed using administrative permissions to the workstation.
  5. The UNC path for the application folder MUST NOT CONTAIN SPACES.

Un-Void Medical, Expense, Indemnity Transactions

posted Feb 14, 2011, 12:01 PM by Compensate Admin   [ updated Jul 13, 2011, 10:20 AM ]

To un-void a transaction that has been previously voided - you need to "Void the Void Transaction"
  1. Right Click on the voucher number for the negative transaction (-1,881.63 in the image below) of the transaction you wish to un-void.
  2. Enter a reason you wish to un-void the transaction.
  3. Click the Void button in the lower left of the transaction review screen.
  4. If it was successful - payment history will look like the original transaction was never voided.
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.

Claim / HRMS Screen Right Click

posted Feb 14, 2011, 7:09 AM by Compensate Admin   [ updated Feb 14, 2011, 7:16 AM ]


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.

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