AHA Coding Clinic® for HCPCS - 2004 Issue 2

Medicare makes data requirement changes

Since the implementation of Health Insurance Portability and Accountability Act (HIPAA) transaction and code set standards by Medicare, a number of issues with Coordination of Benefits (COB) have emerged. In order to process the 837 Institutional HIPAA claim transaction correctly, CMS has changed certain data elements needed to settle the Medicare claims submitted on or after July 6, 2004. The issues stem from the designation of “inpatient” and “ outpatient” claims by Medicare. Medicare’s data requirements for outpatient claims differ from those of other payers who treat the same claims as inpatient. This difference in the treatment...

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