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Billing

Using 2007 Replacement Codes

The TMA Office of General Counsel (OGC) opined that the TMA UBO billing rates are associated with the procedure, not necessarily with a specific CPT procedure code. This year (2007), a number of CPT procedure codes were one-for-one changes, due to "housekeeping"-type issues. For instance, a number of mammograms were re-numbered but the description stayed exactly the same.

If a payor denies any of the procedures, billed with codes in the "2006 Deleted Codes" column of this document,( Click here for the list of deleted and replacement codes xls 14.0 KB ) due to the 2006 code being used for a procedure done in 2007, it is permissible for the biller to resubmit the bill substituting the associated code in the "2007 Replacement Code" column. There is no need to check with a coder. The bill is for the procedure. The code in the "2007 Replacement Code" column is the correct code for the procedure if it was performed after 1 Jan 2007.

It is NOT PERMISSABLE to change any of the other renumbered codes as there is not an exact one-for-one replacement. It is a Service decision whether to implement or not implement this guidance.

There will be no update to the CY2006 rate tables. Therefore, it will not be possible to generate the corrected bill in TPOCS as there are no rates associated with codes in the "2007 Replacement Code" column. I suspect all resubmissions would need to be manually generated.

Uniform Business Office Program Manager - (Posted 4-26-07)

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DoD/VA Billing

Below are links to documents that provide the current policy for inpatient billing; FY07, FY08, and FY09 calculators to assist users in computing the DRG-based rate for inpatient institutional services; and instructions for using the calculators.

Inpatient Institutional Billing Calculator for FY11

Inpatient Institutional Billing Calculator for FY10

Inpatient Institutional Billing Calculator for FY09 xls 5095.0 KB

Inpatient Institutional Billing Calculator for FY08 xls 5323.5 KB

Inpatient Institutional Billing Calculator for FY07 xls 4432.0 KB

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Performance Measurements

Metrics

FY10 TPCP Metrics Reports

The fourth quarter cumulative fiscal year 2010 TPCP Metrics Reports are posted below. These reports are Microsoft Excel-formatted extracts from the Web-based reporting system.

4th Quarter FY10 Collections Summary xls 1287.0 KB
4th Quarter FY10 All Measures Report xls 7672.5 KB

FY09 TPCP Metrics Reports

The fourth quarter cumulative fiscal year 2009 TPCP Metrics Reports are posted below. These reports are Excel-formatted extracts from the Web-based reporting system.

4th Quarter FY09 Collections Summary xls 1285.5 KB
4th Quarter FY09 All Measures Report xls 6985.5 KB

FY08 TPCP Metrics Reports

The fourth quarter cumulative fiscal year 2008 TPCP Metrics Reports are posted below. These reports are Excel-formatted extracts from the Web-based reporting system.

FY08 Collections Report xls 1255.5 KB
FY08 All Measures Report xls 6002.0 KB
FY08 TPCP Analysis Summary xls 1678.5 KB

FY07 TPCP Metrics Reports

The fourth quarter cumulative fiscal year 2007 TPCP Metrics Reports are posted below. These reports are Excel-formatted extracts from the Web-based reporting system.

FY07 Collections Report xls 1245.5 KB
FY07 All Measures Report xls 5475.0 KB
FY07 TPCP Analysis Summary xls 1550.5 KB

Goals

FY 2010 TPCP Collection Goals by Service pdf 966.6 KB
FY 2008 TPCP Collection Goals by Service pdf 942.3 KB
FY 2007 TPCP Collection Goals by Service pdf 303.4 KB

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MHS Rates

Ambulance

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Anesthesia

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CMAC

CY2010 UBO CMAC-based rate files became effective on 1 July 2010 and can be downloaded from the link below.
CY2010 UBO CMAC-Based Rate Files zip 21742.7 KB

CY2009 UBO CMAC-based rate files became effective on 1 July 2009 and can be downloaded from the link below.
CY2009 UBO CMAC-Based Rate Files zip 21490.4 KB

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Cosmetic Surgery

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Dental

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DME

  • Durable Medical Equipment rates for 2010 (posted 7-2-10)
    2010 DME Rates xls 335.5 KB
  • Durable Medical Equipment rates for 2009 (Updated 7-1-09)
    2009 DME Rates xls 339.5 KB
  • Durable Medical Equipment rates for 2008 (Updated 6-25-08)
    2008 DME Rates xls 297.0 KB
  • Durable Medical Equipment rates for 2007 (Updated 5-22-2007)
    2007 DME Rates xls 284.5 KB
  • Updated Durable Medical Equipment rates for 2006 (Updated 3-2-2007)
    Updated 2006 DME Rates xls 264.0 KB
  • Durable Medical Equipment rates for 2005 (Updated 8-31-2005)
    2005 DME Rates, XLS 255kb
  • Durable Medical Equipment rates for 2004 (Updated 8-27-2004)
    2004 DME Rates xls 272.0 KB
  • Durable Medical Equipment rates for 2002 (Updated 10-1-2002)
    2002 DME Rates, XLS 271kb

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IMET/IOR

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Immunization

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Inpatient

Direct Care Inpatient Billing Rates

Standard effective dates for inpatient rates are from 1 October through 30 September, annually.

Long Stay Threshold

  • This table provides the DRG weights and length of stay outlier threshold data for FY10
    2010 DRG Case Weights and LOS Outliers xls 171.5 KB
  • This table provides the DRG weights and length of stay outlier threshold data for FY09
    2009 DRG Case Weights and LOS Outliers xls 176.5 KB
  • This table provides the DRG weights and length of stay outlier threshold data for FY08
    2008 DRG Data File xls 104.0 KB
  • This table provides the DRG weights and length of stay outlier threshold data for FY07
    2007 DRG Data File xls 109.0 KB
  • This table provides the DRG weights and length of stay outlier threshold data for FY06
    2006 DRG Data File xls 101.5 KB
  • This table provides the DRG weights and length of stay outlier threshold data for FY05
    2005 DRG Data File xls 113.5 KB

Outpatient

Outpatient Billing Rates

Standard effective dates for outpatient rates are from 1 July through 30 June, annually.

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MAC

MAC rates are effective upon publication in the Federal Register. Refer to date of service to determine which rate file applies.

Inpatient MAC Rates

5 May 2010 through 20 Mar 2011 - FY10 Inpatient Billing Rates
15 Jan 2009 through 4 May 2010 - FY09 Inpatient Billing rates
6 Mar 2008 through 14 Jan 2009 - FY08 Inpatient Billing rates

Outpatient MAC Rates

15 Dec 2009 through 21 Nov 2011 - CY09-10 Outpatient Billing rates
25 Nov 2008 through 14 Dec 2009 - CY08 Outpatient Billing rates
21 Nov 2007 through 24 Nov 2008 - CY07 Oupatient Billing rates

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Mapping Tables

CY10 Mapping Tables
CY10 TPOCS Mapping Table xls 2300.5 KB
CY10 DMIS ID to CMAC Locality Mapping Table xls 1441.5 KB
CY10 Modifier Mapping Table xls 304.0 KB
CY10 Revenue Mapping Table xls 6185.0 KB

FY09 Mapping Tables
FY09 TPOCS Mapping Table xls 1800.0 KB
FY09 DMIS ID to CMAC Locality Mapping Table xls 1412.5 KB
FY09 Modifier Mapping Table xls 462.5 KB
FY09 Revenue Mapping Table xls 6237.5 KB

FY08 Mapping Tables
FY08 TPOCS Mapping Table xls 1736.0 KB
FY08 DMIS ID to CMAC Locality Mapping Table xls 1053.0 KB
FY08 Modifier Mapping Table xls 498.0 KB
FY08 Revenue Mapping Table xls 5102.5 KB

FY07 Mapping Tables
FY07 TPOCS Mapping Table xls 1803.0 KB
FY07 DMIS ID to CMAC Locality Mapping Table xls 1009.5 KB
FY07 Modifier Mapping Table xls 457.0 KB
FY07 Revenue Mapping Table xls 5881.0 KB

FY06 Mapping Tables
FY06 TPOCS Mapping Table xls 12678.0 KB
FY06 DMIS ID to CMAC Locality Mapping Table xls 989.0 KB
FY06 Modifier Mapping Table xls 426.5 KB
FY06 Revenue Mapping Table xls 8571.5 KB

FY05 Mapping Tables
FY05 TPOCS Mapping Table xls 1311.5 KB
FY05 DMIS ID to CMAC Locality Mapping Table xls 890.5 KB
FY05 Modifier Mapping Table xls 391.0 KB
FY05 Revenue Mapping Table xls 5001.5 KB

FY04 Mapping Tables
FY04 TPOCS Mapping Table xls 2734.0 KB
FY04 DMIS ID to CMAC Locality Mapping Table xls 1106.5 KB
FY04 Revenue Mapping Table xls 4985.0 KB

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Pharmacy

Pharmaceutical Price Estimator

Pharmacy Rate Tables

Pharmacy Dispensing Fee

Prior to July 2007, a pharmacy dispensing fee was added to the charge to cover the cost of dispensing the prescription. Pharmacy dispensing fees are listed below.

  • Pharmacy dispensing fee for 2006 - $8.00 (Updated 5-10-2006)

    CY06 Outpatient Dispensing Fee Methodology ppt 15656.5 KB
  • Pharmacy dispensing fee for 2005 - $8.00 (Updated 8-31-2005)
  • Pharmacy dispensing fee for 2004 - $7.00 (Updated 8-27-2004)

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Newsletter

FY 2011

Apr - Jun 2011 UBO Newsletter pdf 252.2 KB
Jan - Mar 2011 UBO Newsletter pdf 451.8 KB
Oct - Dec 2010 UBO Newsletter pdf 131.8 KB

2010

Jul - Sep 2010 UBO Newsletter (pdf 80.9 KB)
Jan - Jun 2010 UBO Newsletter (pdf 101.4 KB)

2009

Oct - Dec 2009 UBO Newsletter (pdf 500.3 KB)
Jul - Sep 2009 UBO Newsletter (pdf 317.3 KB)
Apr - Jun 2009 UBO Newsletter (pdf 61.7 KB)
Jan - Mar 2009 UBO Newsletter (pdf 266.5 KB)

2008

Oct - Dec 2008 UBO Newsletter (pdf 269.1 KB)
Jul - Sep 2008 UBO Newsletter (pdf 328.7 KB)
Apr - Jul 2008 UBO Newsletter (pdf 696.6 KB)
Jan - Mar 2008 UBO Newsletter (pdf 225.0 KB)

2007

Oct - Dec 2007 UBO Newsletter (pdf 243.1 KB)
Aug - Oct 2007 UBO Newsletter (pdf 292.7 KB)
May - Jul 2007 UBO Newsletter (pdf 54.5 KB)
Jan - Apr 2007 UBO Newsletter (pdf 228.4 KB)

2006

Oct - Dec 2006 UBO Newsletter (pdf 235.4 KB)
Jul - Sep 2006 UBO Newsletter (pdf 247.4 KB)
Apr - Jun 2006 UBO Newsletter (pdf 190.0 KB)
Jan - Mar 2006 UBO Newsletter (pdf 210.0 KB)

2005

Oct - Dec 2005 UBO Newsletter (pdf 177.3 KB)
Jul - Sep 2005 Ubo Newsletter (pdf 152.0 KB)
Apr - Jun 2005 UBO Newsletter (pdf 135.3 KB)
Jan - Mar 2005 UBO Newsletter (pdf 102.8 KB)

2004

Nov - Dec 2004 UBO Newsletter (pdf 124.1 KB)

2003

Nov - Dec 2003 UBO Newsletter (pdf 239.7 KB)

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PATCAT

  • 2010 PATCAT Table
  • 2007 PATCAT Table (updated 12-11-06)
  • 2005 PATCAT Table (updated 8-1-05)
  • 2003 PATCAT Table
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    SIT/OHI

    Use of Placeholder Policies doc 39.5 KB

    2006 SIT/OHI Conversion Documents

    March 2006 SIT Listing xls 1953.1 KB
    March 2004 SIT Listing xls 998.5 KB
    Updated March 2004 HICs xls 64.5 KB

    2008 SIT Cleanup

    SIT Clean-Up Procedure (Revised 3-20-08) doc 35.0 KB

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    Documents

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    Teleconferences and Webinars

    Webinars

    2011

    2010

    • 2011 Updates to ICD-9 Codes This Webinar provides updates for the 2011 ICD-9 Diagnosis Codes. Understand what will be added, revised and deleted for 2011.
      Webcast:
      2011 Updates to ICD-9 Codes

      Presentation:
      Updates to ICD-9 Codes (pdf 537.4 KB)
      NOTE: To view presenter's notes, hover over comment bubble icon in top left-hand corner of PDF. Not all pages contain notes.

      Supplemental Materials
      The 2011 Updates to ICD-9 Codes handout is posted below.
      2011 Updates to ICD-9 Codes Handout (xls 65.5 KB)


    • FY10 Pharmacy Rates, An Overview of the UBO Pharmacy Rate Development Process
      This presentation provides key concepts for understanding UBO Pharmacy Rates, including a background on Pharmacy Rate-setting methodology. Pharmacy Rate file details are explained, with the presentation concluding in a demonstration of the Pharmacy Pricing Tool Estimator (PPET).
      Webcast:
      2010_08 Pharmacy Rates Webinar

      Presentation:
      2010 UBO Pharmacy Rates (pdf 963.1 KB)


    • 2011 Conference Speakers Tips
      This Webinar offers pointers and information for speakers at the 2011 MHS Revenue Cycle Educational Conference.
      Webcast:
      2011 Conference Speaker Tips

      Presentation:
      2011 Conference Speakers Tips (ppt 587.5 KB)


    • 2010 Outpatient Itemized Billing Rates Update
      This presentation provides an overview of Outpatient Itemized Billing (OIB), CMAC/CMAC Component Rates, Associated Rate Tables (MEPRS Based Rates), and Mapping Table Updates.
      Webcast:
      2010 OIB Webcast

      Presentation:
      OIB Rates Update (pdf 278.1 KB)


    • Cosmetic Surgery Estimator Version 6.0 Introduces the Cosmetic Surgery Estimator (CSE) v6.0, and includes a background on Health Affairs Policy 05-020, the CSE Estimate Process, 2010 Rate Methodology, 2010 Updates and Enhancements, CSE practice scenarios, and CSE v6.0 distribution and effective dates.
      Webcast:
      2010 CSE Version 6.0 Webcast
      Presentation:
      2010 CSE Version 6.0 (pdf 2709.7 KB)


    • Cosmetic Surgery Estimator Version 5.0
      This presentation introduces the Cosmetic Surgery Estimator (CSE) v5.0, and includes a background on Health Affairs Policy 05-020, the purpose of CSE, cost of elective cosmetic procedures, CSE v5.0 application changes, practice scenarios, and CSE v5.0 distribution and effective dates.
      Webcast:
      2009 CSE Version 5.0 Webcast

      Presentation:
      2009 CSE Version 5.0 (pdf 1101.8 KB)


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