Hospital Logo. Title: Potential Warranty Covered Devices: Operational and Charge Entry (Draft) Number: Version 6. Applies to: Review Date: 10/31/11
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1 Hospital Logo Handout #2 Title: Potential Warranty Covered Devices: Operational and Charge Entry (Draft) Number: Version 6 Department: Effective Date: Applies to: Review Date: 10/31/11 Approved by, date: Revision Date: 10/31/11 PURPOSE: Successful management of handling (e.g. revenue and expenses) of potential no-cost and reduced cost devices requires a coordinated effort between the Site of Service, Clinician, Charge Capture Employees, Coders, Materials Management, Vendor and Finance. DEFINITIONS: Inventory On hand or available quantity of supply items (owned or consigned) from which devices are selected for implant. Supply Item Device specific to procedure (Implant/Explant) Consigned Inventory Supply item for which Hospital has not made payment and for which payment is contingent on the supply item being implanted. Cost Contracted price charged by vendor to Hospital for device Hospital Mark-up: The Hospital defined schedule of mark ups over costs on supplies. Invoice Supplier s demand notice for payment Credit Invoice Supplier s return of credit against previous payment (may also be referred to as Credit Memo or Credit). Invoice Number Numeric identifier unique to each invoice or credit invoice. Date of Service (DOS) Date of implant/explant ASSUMPTIONS: Departmental Asset Manager provides Departmental Billing Coordinator with cost of supply item that has been provided by Materials Management and vendor agreement. Vendor is notified prior to procedure to be present during explant/reimplant. Tracking spreadsheet is stored on SharePoint: xxx PROCEDURE: 1. Patient has procedure with implantable device. A. If done in OR, circulator places all device/lead information on the patients chart for notification to the OR Billing Supervisor and Asset Inventory Manager. 2. Billing Coordinator applies mark-up to determine charge of supply item. Charges entered into legacy system. Charges transfer electronically to legacy system. 3. Vendor will provide the Department s Billing and Compliance Coordinator with a hardcopy Vendor Standard and Supplemental Warranty Claim Form at the date of explant/reimplant for lead recall/credit request. A. If done in OR, correspondence occurs between EP lab and the OR to assure that patients are properly billed for the hardware used according to warranty guidelines. See Exhibit A 4. Hospital Credit Request form will also be completed and submitted to vendor. See Exhibit B 5. Hospital form is to be used as an internal tracking form for all generator changes done in the EP lab Page 1 of 11 Last Updated: 6/12/2013
2 a. All explant/reimplant changes (generator and lead) will be tracked regardless if it is known that a credit is due to the department b. The EP/CDIC department will use this form as a follow up to verify whether or not a credit is due to the patient I. If a credit is due we will pursue our process to credit the patient's account II. If no credit is due the patient will be cleared from our follow up list as "no credit/warranty applicable" 6. The explanted generator or lead is taken back with the vendor for evaluation. A warranty credit, if appropriate, is determined. 7. Billing Coordinator sends spreadsheet to vendor requesting a credit. 8. Vendor returns spreadsheet with credit memo number and amount. 9. In regards to outstanding credits, as an ongoing process the Department Billing Coordinator will communicate with vendor on a monthly basis for status of evaluations pending. 10. If a warranty credit is applied, the vendor will supply the Department s Billing and Compliance Coordinator with documentation including credit memo number, patient name, the original date of implant, the date of service, Model Number and Serial Number of both the new and old lead and/or device, PO# and amount of the credit within 30 business days of date of service. 11. Communication occurs between Departmental Billing and Compliance Coordinator and Asset Manager so that each credit is validated in GL. A. This is done by running AP Distribution Detail or PO Activity report out of Document Direct. i. Credit memo number in doc direct report is compared to PO Number in the spreadsheet 12. Once credit is validated: The Department s Billing/Compliance Coordinator will document on tracking spreadsheet that the credit has been received, by putting a Y in the Credit rec d in Acct s Payable Y/N column. 13. Is claim Inpatient or Outpatient? A. If Inpatient i. The Department s Billing/Compliance Coordinator will determine the appropriate Condition Code to apply to claim and document this code in the tracking spreadsheet. 1. If Yes, a Y will be entered in the Condition Code applied to acct Y/N column 2. The appropriate Condition Code will be entered in the Cond Code 49 or 50 column 49 (Product Replacement within Product Lifecycle) - Replacement of a product earlier then the anticipated lifecycle due to an indication that the product is not functioning properly 50 (Product Replacement for Known Recall of a Product) - Manufacturer or FDA has identified the product for recall and therefore replacement ii. The Department s Billing/Compliance Coordinator will determine if the hospital received a credit for a replaced device that is 50% or greater than the cost of the device. 1. If yes, they will put a Y in the Value Code Needed Y/N column of tracking spreadsheet. B. If Outpatient i. The Department s Billing/Compliance Coordinator will determine the appropriate Modifier to apply to the procedure code that reports the services provided to replace the device (i.e., the surgical procedure) and document this code in tracking spreadsheet. 1. If Yes, a Y will be entered in the Modifier applied to acct Y/N column. 2. The appropriate Modifier will be entered in the Modifier FB/FC column. FB Item provided without cost to provider, supplier or practitioner, or credit received for replacement device (i.e., but not limited to: covered under warranty, replaced due to defect, free samples). FC Partial credit received for replaced device 14. Hospital Pt Accts Team is notified of credit utilizing the tracking spreadsheet stored on SharePoint site. 15. Hospital Pt Accts Team will access original processed claim in FISS and update with the appropriate Condition Code and Value Code, if needed, as determined and documented in steps 13 and 14. A. Once codes are updated and claim is saved to FISS Page 2 of 11 Last Updated: 6/12/2013
3 B. FISS will then ask the user if they want to submit an adjusted claim. When the user selects Yes, FISS creates a Bill Type 117 (INPATIENT: REPLACEMENT OF PRIOR CLAIM) or 137 (OUTPATIENT: REPLACEMENT OF PRIOR CLAIM) 16. Hospital Pt Accts Team will document on the tracking spreadsheet that the adjusted claim has been submitted to the payer, by putting a Y in the Patient Acct Adjusted Y/N. 17. Hospital Pt Accts Team to comment legacy system with any charge credits, charge debits, modifier, condition or value code additions made to FISS. Department Billing Coordinator Department Compliance Coordinator - Asset Manager - Hospital Pt Accts Team Manager Responsible Parties Page 3 of 11 Last Updated: 6/12/2013
4 EXHIBIT A Page 4 of 11 Last Updated: 6/12/2013
5 EXHIBIT B Hospital Logo CDIC, Department of Electrophysiology Generator Change Credit/Warranty Form Vendor: 1. Did the explanted device model# serial number implant date explant date reach its expected life? YES or NO 2. Patient identifier: 3. If no, is the device under warranty? YES or NO EP Lab: a. If yes, what is the credit due? 1. Did the vendor return the device to the company? YES or NO a. If yes, date: b. If no, reason: 2. If credit was due what was the dollar amount? Signatures: a. $ b. Date of credit: c. Patient s account adjusted? YES or NO i. If yes, date: ii. If no, reason Vendor: Print: EP lab: Print: *Please attach billing report, slip and procedure report if applicable. Page 5 of 11 Last Updated: 6/12/2013
6 EXHIBIT D Page 6 of 11 Last Updated: 6/12/2013
7 Page 7 of 11 Last Updated: 6/12/2013
8 Page 8 of 11 Last Updated: 6/12/2013
9 Page 9 of 11 Last Updated: 6/12/2013
10 Page 10 of 11 Last Updated: 6/12/2013
11 Page 11 of 11 Last Updated: 6/12/2013
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