Hospital Rate Sheets

January 17, 2017

Memorandum

Updated HFS Inpatient and Outpatient Hospital Rate Sheets and Calculators
The Department of Healthcare and Family Services (HFS) has released a notice that it posted updated inpatient and outpatient pricing calculators and hospital rate sheets on its website, per the December 29, 2016 notice.

The outpatient pricing calculator contains the new relative weights associated with EAPG grouper version 3.11. In addition, the calculators have been updated to include the new hospital-specific rates and cost-to-charge ratios in order to calculate estimated reimbursement for inpatient discharges and outpatient dates of service on or after January 1, 2017.

Observation Claims Billing Issue
HFS has identified a system problem that caused hospital outpatient claims to reject in error for X75 - MISSING/INVALID HCPCS FOR OBS REV CODE. If a hospital received this error and the claim does not contain observation revenue code 0762, please rebill. This error occurred with claims received between December 23, 2016 and January 3, 2017.

Fee-For-Service Reimbursement for Licensed Clinical Psychologist (LCP) or a Licensed Clinical Social Worker (LCSW)
HFS issued a notice informing providers that it will begin fee-for-service (FFS) reimbursement for certain services provided by Licensed Clinical Psychologists (LCPs) and Licensed Clinical Social Workers (LCSWs) enrolled for participation in HFS Medical Programs beginning with dates of service on or after January 1, 2017. Enrolled providers are not required to make changes in IMPACT in order to bill FFS. Billing instructions and the LCP/LCSW fee schedule will be published in January 2017.

Title Eligibility in 271 Response
HFS sent an e-mail to alert providers of a change effective December 21, 2016 in the 271, electronic Health Care Eligibility Benefit Response, Loop 2110C, MSG01 segment. An update to the Chapter 300 Companion Guide will be made at a later date. Providers are encouraged to pass this information on to their software vendors.

There are now four characters displayed in this segment. Previously, there were only two. The first two characters following the SEE COMPANION GUIDE MESSAGE designate the co-payment message number and the second set of two characters designate the participant’s Title information.

For example: MSG*SEE COMPANION GUIDE MESSAGE – 10 19

In the above example, the first two characters, 10, designate the message number and the following two characters, 19, designate Title 19. The first two characters still correspond to the Special Messages listed in the 270/271 Standard Companion Guide Section 4.3. The range of options for the second two characters that may display are: 19 for Title 19, 21 for Title 21 and SF for State Funded.