MLN Matters® Number: MM6801 Revised
Related Change Request (CR) #: 6801
Related CR Release Date: March 9, 2010
Effective Date: July 1, 2010
Related CR Transmittal #: R1929CP
Implementation Date: July 6, 2010
Note: This article was revised on March 12, 2010, to reflect the revised CR 6801 issued on March 9, 2010. Reference to article MM6757 was added to the table on pages 2-4. Also, the CR transmittal number, release date, and Web addresses for accessing CR 6801 were changed. All other information remains the same.
Provider Types Affected
This article impacts providers submitting claims to Medicare contractors (Fiscal Intermediaries (FIs), A/B Medicare Administrative Contractors (A/B MACs), and/or Regional Home Health Intermediaries (RHHIs)) for services provided to Medicare beneficiaries.
Provider Action Needed
STOP – Impact to You
This article is based on Change Request (CR) 6801 which updates the Point-of-Origin for Admission or Visit Codes to the UB-04 (CMS-1450) Manual Code List.
CAUTION – What You Need to Know
The following Point of Origin for Admission or Visit (formerly Source of Admission) codes (discontinued by the National Uniform Billing Committee (NUBC)) will be discontinued for use by Medicare Systems: ‘7’- Discontinued Effective July 1, 2010; ‘B’ - Discontinued Effective July 1, 2010; and ‘C’ - Discontinued Effective July 1, 2010. In addition, Point of Origin for Admission or Visit code ‘1’ example and definition language has been updated, though the processing of code ‘1’ is not being changed. Also, Point of Origin for Admission or Visit code ‘2’ definition language has been updated, though the processing of code ‘2’ is not being changed.
GO – What You Need to Do
Be sure billing staff are aware of these changes.
Background
The Centers for Medicare & Medicaid Services (CMS) Health Insurance Claim Form (UB04) and its electronic equivalence has a required field (Form Locator (FL) 15) on all institutional inpatient claims and outpatient registrations for diagnostic testing services. FL 15 indicates the point of patient origin for the admission or visit of the claim being billed.
The Point of Origin for Admission or Visit (formerly Source of Admission) codes ‘7’, ‘B’, and ‘C’ (discontinued by the National Uniform Billing Committee (NUBC)) will be discontinued for use by the Fiscal Intermediary Standard System (FISS) effective July, 1, 2010. In addition, Point of Origin for Admission or Visit code ‘1’ example and definition language has been updated (the processing of code ‘1’ is not being changed), and Point of Origin for Admission or Visit code ‘2’ definition language has been updated (the processing of code ‘2’ is not being changed). These revisions are shown in the following table:
Form Locator (FL) 15 - Point of Origin for Admission or Visit
Required: The provider enters the code indicating the source of the referral for this admission or visit.
Code Structure
|
Code
Structure
| Referral |
Point of Origin
|
| 1 |
Non-Health Care Facility Point of Origin (Physician Referral) Effective July 1, 2010: Non-Health Care Facility Point of Origin
Usage note: Includes patients coming from home, a physician’s office, or workplace. Effective July 1, 2010: Examples: Includes patients coming from home or workplace.
|
Inpatient: The patient was admitted to this facility upon an order of a physician.
Effective July 1, 2010: Inpatient: The patient was admitted to this facility.
Outpatient: The patient presents to this facility with an order from a physician for services or seeks scheduled services for which an order is not required (e.g., mammography). Includes non-emergent self referrals.
Effective July 1, 2010: Outpatient: The patient presented to this facility for outpatient services.
|
|
2
|
Clinic
|
Inpatient: The patient was admitted to this facility as a transfer from a freestanding or non-freestanding clinic. Effective July 1, 2010: Inpatient: The patient was admitted to this facility.
Outpatient: The patient was referred to this facility for outpatient or referenced diagnostic services.
Effective July 1, 2010: Outpatient: The patient presented to this facility for outpatient services.
|
|
7
|
Emergency Room (ER)
|
Inpatient: The patient was admitted to this facility after receiving services in this facility’s emergency room department.
Discontinued July 1, 2010
|
|
B
|
Transfer From Another Home Health Agency
|
|
|
C.
|
Readmission to Same Home Health Agency
|
|
Additional Information
If you have questions, please contact the Palmetto GBA Provider Contact Center at their toll-free number (866) 801-5301.
Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.