AUC Operations Meeting Advances Three Best Practices
The AUC committee-of-the-whole, known as the Operations Committee, held its regular quarterly meeting September 10, 2019. The meeting focused on recent activities and work of the AUC Eligibility Technical Advisory Group (TAG), including its recent development and approval of three new “best practices” to address challenges and obtain greater information value in the exchange of the X12 v5010 270-271 Eligibility Inquiry and Response transaction.
As noted in introductory comments at the start of the meeting, AUC remembers reported in a 2018 survey that the 270-271 transaction was one of three transactions with the highest potential returns on investment. However, the same survey also found that rates of fully electronic, automated exchanges of the transaction lagged behind other transactions, in part because desired information on patient coverage and benefits was perceived to be often more accurate, detailed, and accessible via websites or phone calls.
The Eligibility TAG co-chairs, Susan Brousseau and Tim Lopez, described how the TAG, using the survey results above as a starting point, conducted additional discussions and brief surveys of the TAG to further identify and address key challenges (“pain points”) experienced by providers and payers with the 270-271. The TAG identified and prioritized several key pain points to be addressed, including the need for correct membership information, reporting of multiple payers, and multiple service and funding types. The co-chairs explained that the TAG recently developed and approved three best practices with instructions and examples to improve the use of the 270-271, including:
- Reporting Other or Additional Payer Information -- Provides reporting of other or additional payer information for a member when the information source has found the member to be active (active coverage response) and the other or additional payer information is known.
- Multiple Service Type Inquiry/Response -- This Best Practice provides a mechanism for Information Receivers to request eligibility on multiple Service Types when needed to obtain information related to multiple Service Types. Information Sources would return an explicit response based on the Service Types requested by the Information Receiver.
- Reporting Funding Type This Best Practice provides a mechanism for Information Sources to report the Funding Type of the member’s group for an active response and applies to the 271 - Loop 2110C or 2110D, MSG segment.
The best practices above were reviewed and discussed in greater detail at the meeting. Per established AUC policies, the best practices must now be approved by the Operations Committee. If approved by the Committee, they will be posted on the AUC website and will be publicized and promoted for broad adoption and use.
Final approval is now pending an email vote by committee members to be completed by September 27. The Eligibility TAG plans to continue developing additional best practices to address other priority challenges and paint points for most effective exchange and use of the 270-271 transaction.
In addition to the Eligibility TAG work described above, the Operations Committee also received updates regarding:
- work underway by the Medical Code TAG to revise a significant portion of the Minnesota Uniform Companion Guides for the 837 Professional and 837 Institutional transactions (with revisions of the “coding appendix”); and
- X12’s response to the AUC comments submitted regarding X12’s proposed v7030 835 Implementation Guide.
More information regarding the AUC and the Operations Committee is available on the AUC Website.
It's fall -- proper coding for flu shots and vaccinations is as important now as a jacket in the morning
Fall - a time for rolling out the pumpkin-spiced lattes, and reminders about getting flu shots. The AUC Medical Code TAG suggested at its most recent meeting on September 24 that a few seasonal reminders about proper coding for flu shots and other vaccinations are important too, and follow below.
Initial Vaccine Administration Code Reporting
Initial Administration Code Sets
There are three code sets that can be used to report initial vaccine administration codes:
- 90460 - Used for face-to-face counseling to the patient and/or family for patients younger than 19 years old
- 90471, 90473 - Used when there is no face-to-face counseling for patients of any age
- G0008 - G0010 - Used on a limited number of vaccines (usually Medicare beneficiaries)
When more than one vaccine is given during the same visit, a decision as to which initial administration code to report must be made:
- Report only one initial administration code per claim. Additional initial administration code(s) will result in claim denial.
- Report counseling administration codes (90460 - 90461) before non-counseling administration codes (90471 - 90474).
- Report administration codes for injectable vaccines (90460 - 90461, 90470 - 90472) before oral or intranasal vaccines (90473 - 90474).
Apply units to the subsequent administration code (90461, 90472, 90474) for every additional vaccine (two or more) of the same type (injectable or oral).
Vaccine Administration Codes
- 90460 - Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first or only component of each vaccine or toxoid administered
- 90461 - Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; each additional vaccine or toxoid component administered (List separately in addition to code for primary procedure)
- 90471 - Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid)
- 90472 - Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure)
- 90473 - Immunization administration by intranasal or oral route; 1 vaccine (single or combination vaccine/toxoid)
- 90474 - Immunization administration by intranasal or oral route; each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure)
- G0008 - Administration of influenza virus vaccine
- G0009 - Administration of pneumococcal vaccine
- G0010 - Administration of hepatitis B vaccine
Mary Myslajek recognized for AUC leadership and service
Mary Myslajek, an active AUC member for more than 20 years, and most recently AUC co-chair 2017-2019, was recognized for her outstanding service and leadership with the AUC at the September 10, 2019 Operations Committee meeting. Mary retired from Hennepin Health in August 2019. We thank her for her leadership and many contributions over the years and wish her the best in retirement!
Reminder - Providers must use new Medicare Beneficiary Identifiers by January 1, 2020
At its regular quarterly meeting in March 2018, the AUC discussed the federal Centers for Medicare & Medicaid Services’ (CMS) plans for implementing a new “Medicare Beneficiary Identifier (MBI)” to replace the previous SSN-based Health Insurance Claim Number (HICN). CMS has recently provided updated information and reminders regarding the MBI, including:
- All new Medicare cards with the MBI have been mailed to Medicare beneficiaries;
- Providers are encouraged to use the MBIs now to protect patient identities; and
- With only a few exceptions, starting January 1, 2020 physicians, providers, and suppliers submitting claims to Medicare Administrative Contractors (MACs), including Durable Medical Equipment MACs (DME MACs) and Home Health and Hospice MACs, for services provided to Medicare beneficiaries, are required to submit MBIs instead of HICNs on claims and eligibility transactions. With only a few exceptions, CMS will reject claims submitted with HICNs after January 1, 2020.
Medicare Advantage and Prescription Drug plans continue to assign and use their own identifiers on their health insurance cards. For patients in these plans, providers are advised to continue to ask for and use the plans’ health insurance cards.
For more information, please see the related MLB Matters article SE18006, “New Medicare Beneficiary Identifier (MBI) Get It, Use It.”
X12 Posts Updated Public Review Periods for X12N 7030TM Technical Reports
Designated Standards Maintenance Organizations (DSMOs) are organizations named by the Secretary of Health and Human Services (HHS) to maintain standards adopted under HIPAA regulations and to receive and process requests to adopt new standards or modify existing standards. One DSMO, X12, is currently developing a set of guides for the implementation of HIPAA-required standard, electronic health care administrative transactions.
The new implementation guides, also known as Technical Report Type 3 (TR3) have been labeled as version 007030 (“7030TM”), and if adopted under HIPAA in the future will supersede the current X12 version 5010 TR3s now required for use by covered entities and transactions subject to HIPAA.
As part of the 7030TM TR3 development process, each TR3 is presented for one or more public review and comment periods. X12 has recently updated information regarding the public reviews. A number of the 7030TM TR3s will be posted for public review over the next several months, including a second public review of the 837 health care claim guides, scheduled October 15 - November 29, 2019. For more details, see the information posted on the X12 website, especially in the “Public Review Pending” section.
DHS Provider News
The Minnesota Department of Human Services (DHS) administers several publicly funded health programs (“Minnesota Health Care Programs (MHCP))” including Medical Assistance, Minnesota’s name for Medicaid. DHS is a “group purchaser” (payer) subject to Minnesota Statutes, section 62J.536 requirements for the standard, electronic exchange of certain health care administrative transactions.
DHS is also an active member and participant on the AUC, and publishes a regular electronic newsletter with news and resources for providers enrolled to serve MHCP members. Given that the DHS “MHCP provider news and updates” newsletter may be of interest to AUC members as well, all issues of this newsletter will also include a “reminder” link to the DHS newsletter webpage for easy reference. Providers may also sign up to receive the DHS newsletter directly through DHS’s free provider email lists.