Please pardon the cross-post to "transactions", but this reminds me of a couple other version-date issues that I'd like to bounce off the transaction gurus. If the code-set version is determined by "date of service", what will drive the choice of code-set for transactions sent in advance of the actual service... like the 270? In any case, it appears that senders will have to maintain current and [possibly several] previous code-sets so that claims submitted [up to a year, possibly] after a code-set update can be created with the codes that were in effect on the date of service... right?
My other question is regarding the correct transaction version to use, which (if I understand correctly) is driven by the date of the transaction, as opposed to the service-date. So, does this mean that a claim REsubmitted after the required implementation date of new transaction version, would have to be reformatted for the new transaction version?
Would there ever be a scenario in which a sending system's translator or a receiving system's validator would have to be able to support BOTH old and new transaction versions? If so, which date-field in the interchange determines the choice of transaction version?
Thanks,
-Chris
Christopher J. Feahr, OD
Optiserv Consulting
[For the vision care industry]
Santa Rosa, CA
707-579-4984
707-529-2268 (cell/pager)
http://VisionDataStandard.org
http://Optiserv.com
At 03:09 PM 10/11/2002 -0400, Ratayski, Dawn wrote:
Hi Dawn,
I had the same concern and have brought it to the BCBSA association along
with many other Blues plans nationwide to address with CMS. CMS is choosing
not to change their practices at this time.
HIPAA does not address this. CMS is a covered entity under HIPAA and the
regs state the codes must be valid for the date of service for which they
are billed. This means NO grace period. CMS is sending and inconsistent
message to the provider community by continuing to allow a grace period.
[EMAIL PROTECTED]
TCI Project Developer
Blue Cross of Northeastern Pennsylvania
-----Original Message-----
From: Ossont, Dawn x405 [mailto:dossont@;preferredcare.org]
Sent: Friday, October 11, 2002 1:12 PM
To: '[EMAIL PROTECTED]'
Subject: Code set effective dates
Hello,
I'm looking for any information regarding the effective dates of ICD-9-CM
and HCPCS code sets. CMS currently allows providers to utilize a grace
period. For example, providers are not required to use HCPCS codes until
4/1 (and they can start submitting 1/1). How does HIPAA address this?
Thanks!
Dawn Ossont
Reimbursement Team Leader
Preferred Care
phone: 716.327.2405
fax: 716.327.2289
e-mail: [EMAIL PROTECTED] <mailto:dossont@;preferredcare.org>
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