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Consolo Services | CMS Change Request 8358 – User Guide P a g e | 1

CMS Change Request 8358 _________________________________________________________________________

User Guide

Required April 1, 2014

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CMS Change Request 8358 Required April 1, 2014

User Guide

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Overview:

CMS Change Request (CR) 8358 requires Claims to include more details relating to the

following areas of providing Hospice Care:

Medication Fill Data

o Injectable Prescription Drugs

o Non-injectable Prescription Drugs

o Infusion Pumps and Infusion Drugs

Post Mortem Visits | Visits Completed on Date of Death for the following Types of

Hospice Employees

o Nurses

o Hospice Aides

o Social Workers

o Therapists

Facility Details

National Provider Identifier (NPI) and 9 digit Zip Code of the Nursing Facility, Hospital, or

Hospice Inpatient Facility where patient receives services

General inpatient Care (GIP) Visit Details

Line item visit data for hospice staff provided under general inpatient care (GIP) in

skilled nursing facilities (SNF) or hospitals

This User Guide defines the processes within Consolo to meet the specification of CMS Change

Request 8358. Please refer to the Help Menu / Training Videos for further Training opportunities.

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CMS Change Request 8358 _________________________________________________________________________________

Medications – General Information

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Medications | Populating Claims with Details Relating to CMS Change Request 8358

The Consolo Services Team has established solutions for meeting the updated reporting

requirements set forth by CMS in Change Request 8358. CMS is requesting Hospice providers

display the following details on claims processed for Hospice Medicare Part A Beneficiaries:

Details from CMS:

Report Injectable Drugs

Line-item bill per Medication Fill

Revenue code = 0636

HCPCS code for drug - See list at

http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/Downloads/DRUG201

4.pdf

Units = amount filled based on HCPCS description

Example: HCPCS Q1234 is for 100 mg, and fill was 200 mg, report 2 units

Charges

Service Date

Example from CMS:

Report Non-Injectable Drugs

Line-item bill per Medication Fill

Revenue code = 0250

National Drug Code (NDC) List available at:

http://www.fda.gov/drugs/informationondrugs/ucm142438.htm

Quantity - NDC qualifier is quantity of drug filled, reported as unit of measure

Charges

Service Date

NDC is reported - 11 digit NDC (no hyphens)

http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/Downloads/DRUG2014.pdf


http://www.fda.gov/drugs/informationondrugs/ucm142438.htm

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Report Non-Injectable Drugs (Continued)

Unit of Measurement Qualifier

F2= International Unit

GR = Gram

ME- Milligram

ML = Milliliter

UN = Unit

Report Infusion Pumps and Infusion Drugs

Line-item bill per Pump Order

Line-item bill per Medication Refill

Revenue Codes = 0291 (pump, rented); 0292 (pump, new); 0293 (pump, used); and

0294 (drugs)

HCPCS = appropriate code

See list of HCPCS for drugs at:

http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/Downloads/DRUG201

4.pdf

Units

Charges

Service date

Example from CMS:



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Consolo Methods for Populating Claims with Medication Details

Consolo has developed three methods to obtain the Medication Fill Data from pharmacies

and add it to Claims to meet the specifications defined by CMS in Change Request 8358. The

three methods are summarized below and the complete processes are defined in the pages

that follow:

Method I - Automated Claims Integration with Pharmacy Benefit Managers

Consolo is working with a number of Pharmacy Benefit Managers (PBMs) to automate

the Medication Fill data into Consolo. The PBMs are able to send data in a specific

format via secure transport, including the Patient ID, directly to Consolo’s Integration

Network. Notify [email protected] to begin the implementation with

your PBM.

Method II - CSV File Upload Capability

Consolo has provided a CSV file format that can be shared with local pharmacies. The

pharmacies can provide a file in the required format that may be uploaded into

Consolo. Consolo has created a document with file specifications that may be

distributed to local pharmacies so hospices may work with them with the goal of

obtaining medication details in the proper format for upload. Please find the Retail

Pharmacy CSV Upload document and a Sample CSV File in the Help Menu / Release

Notes Area.

Method III - Data Entry

Consolo is offering a data entry screen within the system where Medication Fill Data

may be manually entered. This method may be used for medication details from local

pharmacies that will only provide the information in paper format.

Identifying Patients to Pharmacies and Pharmacy Benefit Providers (PBMs) | Patient

Identification Number

The Patient Identification Number data is unique and properly identifies Patients within

Consolo. This number is critical to provide to Pharmacies relating to populating Medications on

Claims, as required by CMS CR 8358. The Patient Identification Number is the Unique Number

listed in the Patient URL or Web Address that also lists on:

Patient Search Filter

Faxed Documents

Patient Home Page Header by the Patient Name

More Button on the Patient Home Page

Face Sheets

Active Patient Summary

Medication Report

Note: It is critical to identify Patients to Pharmacies and PBMs using the Patient Identification

Number in order to properly associate Medications to Consolo Patients.

mailto:[email protected]

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Examples of the Patient Identification Number (the Number from the URL):

Patient Home Page (After Patient Name)

More Button Details (from the Patient Home Page)

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Search Screen Filter

Active Patient Summary Report

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Security - Role Changes | Medication Fill

A new Section appears in the Roles Screen for Medication Fills. These options handle the new

functionality relating to CMS CR-8358 allowing the Hospice to track Medication details and

costs associated with each patient.

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CMS Change Request 8358 __________________________________________________________________________________

Populating Medication Data on Claims

Method I - Automated Integration

With Pharmacy Benefit Managers

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Method I - Automated Claims Integration with Pharmacy Benefit Managers (PBMs)

Consolo is working with a number of Pharmacy Benefit Managers (PBMs) to automate

the Medication Fill data into Consolo. The PBMs are able to send the data in a

predetermined format via secure transport, including the Patient ID, directly to

Consolo’s Integration Network.

If a Hospice PBM interfaces directly with Consolo, the Medication Details will be

automatically populated in Consolo. It will be necessary to verify there are no PBM

Import Exceptions by doing the following:

o Go to the Patient Menu

o Select the Medication Fill Records

o Go to Related Links

o Select View PBM Import Exceptions

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o View the Medication Exception to Evaluate and Correct Issues

o Click Enter Medication Fill to Open an Edit Screen to Correct Issues

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Correct Issues and Save

Note: Exceptions should be reviewed prior to processing claims and may not be

deleted

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CMS Change Request 8358 ___________________________________________________________________________________


Method II - CSV Upload Capability

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Method II - CSV File Upload Capability

Consolo has created a document with file format specifications that may be distributed

to local pharmacies so hospices may work with them with the goal of obtaining

medication fill details in the proper format for upload. Please find the Retail Pharmacy

CSV Upload document and a Sample CSV File in the Help Menu / Release Notes Area.

Sample CSV (Column sizes are reduced in this sample)

Note: Retail Pharmacies may create a CSV file in the format above and it may be

imported into Consolo or a Hospice may type the data onto the CSV File and import it into

the system

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CSV Files Created Manually

Pages 15 – 18 describe how to download the CSV File Template so a Hospice may

manually enter medication fill data and then upload it into Consolo. A hospice would

use this method if a Pharmacy does not provide the data in the proper format.

CSV Files Created by a Pharmacy

Page 20 describes how to Upload a CSV File from a CSV file created by a Pharmacy

(and a file that a Hospice Manually Entered).

To Download a copy of the CSV File Template from Consolo and Enter Data for Upload:

Go To the Patient Menu

Select Medication Fill Record

Go to Related Links

Select Import from CSV

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• Select Display Field Information to Learn More about the Fields in the CSV File

Descriptions of Fields on the CSV Import File Display on the Screen

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Select Download Template

Sample CSV Template

Note: Patient Names and ID Numbers will display on the CSV file for all active Patients within

the last 45 days (names may be deleted as needed and rows can be added for multiple

medication fills per patient)

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Enter Medication Data

Notes:

NDC Codes cannot contain Dashes and must be11 Digits. Shorter numbers will be

pre-filled with zeroes.

All drugs must contain the NDC.

Injectable and infusion drugs also have a HCPCS Code, but if the HCPCS field is left

blank, Consolo will fill the HCPCS field from the NDC data.

Infusion Pumps do not have an NDC and require a HCPCS code.

Compounds should be listed as separate line items but should have the same Rx

Number.

Only Prescription Drugs (Rx=Y) display on Claims.

Save File – The File Must be Saved as a CSV (Comma Delimited) File

Note: A CSV File may be saved in Excel

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Uploading a CSV File from a Pharmacy or a CSV a Hospice Manually Entered

Select Choose File

Select File

Select Upload

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Note: Errors appear on the screen in Red, the entire spreadsheet will need to be uploaded

again once errors are corrected, (none of the data will import)

Correct the CSV File and Re-Upload – The Screen below shows a successful import

Note: Recently Entered or imported Medication Fills List on the Page

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Medication Fills may be Created from a Patient Home Page or from the Patient Menu

o Enter Data from the Patient Menu if entering Medications for several Patients

Go To the Patient Menu

Select Medication Fill Records

o To Enter Data from a Patient Home Page

Go to a Patient Home Page

Open the Medication Area

Select Medication Fill Record

o The page will open to the Medication Fill Summary Page

o Select Create a New Medication Fill

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Complete Data Entry Fields

o Create and Continue Adding Medication Fills

Notes:

The Patient Name Field does not appear if accessing from the Home Page

All Drugs must contain the NDC. Type the medication name or NDC in the

Medication Look-up section to find the correct drug.

Injectable and Infusion drugs also have a HCPCS Code, but if the HCPCS field

is left blank, Consolo will fill the HCPCS field from the NDC data.

For Infusion Pumps use the HCPCS Code Look-up instead of the Medication

Look-up.

Quantity would be the number of pills, patches, vials, etc. Do not enter

dosages here.

Only Prescription Drugs display on Claims. Un-check the Prescription check-

box for OTC drugs.

If a Pharmacy or DME Supplier cannot be found in the Look-up, go to the

Services menu and add it.

Individual ingredients of compounds should be entered as separate drugs

and must have the same Prescription Number.

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o Select Medication Fill Records (from the Breadcrumbs) to Return to the Summary

Page

Summary Page – Hand Keyed and CSV Uploaded Medication Fills may be

Edited from this page

Note: Medications will flow to the Claim automatically – The Hospice Claims Team will

not need to do anything to populate Medication Details during the Claims Process

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Medications – Preparing for Claims

Processing

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Compare Against Medication Records – Compare Medications that have been filled are in

the Medication Record:

o Go To the Medication Fill Screen

o Select Related Links

o Select Compare Against Medication Records

o Verification that Medications Filled are in the Medication Record

o Click Copy to Med to Add Medication to the Medication Record

o Add Medication Details for the Medication Record

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Reversing an Entry (Required if a change is needed to Hand Keyed or CSV Uploaded

Entries if a Claim has been Processed)

o Go to a Patient Home Page

o Open the Medication Area

o Select Medication Fill Record

o The page will open to the Medication Fill Summary Page

o Click Icon to View Medication Fill Record

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o Go to Related Links

o Select Create Reversal

o Select Yes Create the Reversal

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o Sample of a Reversal

Claim Sample

Details Regarding Medication Fill Records:

Interfaced Medication Fill Records may not be deleted, but may be edited if there is an

exception to be corrected.

Imported Medication Fill Records may be edited, deleted, and reversed.

Hand-keyed Medication Fill Records may be edited, deleted, and reversed.

Medication Fills of any type may not be deleted or edited if associated to a Claim.

Incorrect Medication Fills must be reversed and a correct Fill can then be entered.

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Facility and GIP Visit Details for Claims

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Facility and GIP Visit Details |Populating on Claims Relating to CMS Change Release 8358

GIP Visit Details

CMS Change Request 8358 requires that when the site of service is a Skilled Nursing Facility,

Hospital, Long Term Care Hospital or Inpatient Psychiatric Facility, visits are reported by the

number of units for all four levels of care including General Inpatient Level of Care. The

changes will be visible on the claims and will not impact charting.

Details from CMS:

Claim Line item Reporting of GIP Visits in SNF (Q5004) or Hospital

(Q5005, Q5007, Q5008)

Applies only to visits provided by hospice staff

Visits by non-hospice staff still not reported

Each Visit is Reported on a separate Revenue Code Line

Units reflect duration of visit, 15-minute increments

Visits under GIP in an inpatient hospice unit (Q5006) are still reported weekly

Sample from CMS:

Facility Details

CMS Change Request 8358 requires a 9 Digit Zip Code and Facility NPI for all Medicare

claims when the patient is in one of the following Facility Types and the NPI of the facility is

different from the Hospice NPI:

o Long Term Care

o Non-Skilled Nursing Facility

o Skilled Nursing Facility

o Hospital

o Long Term Care Hospital

o Inpatient Psychiatric Facility

o Inpatient Hospice Facility

Homecare Hospice Facility

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Details from CMS:

Required Reporting of National Provider Identifier (NPI) to identify Nursing

Facility, Hospital, or Hospice Inpatient Facility

o Location where Patient Receives Services

o Report name, address and NPI

o Claims without NPI will be returned to provider (RTP)

o If care provided in more than one facility in a billing month, report NPI where

Patient last treated

o Claims reporting Q5003, Q5004, Q5005, Q5007 or Q5008 without NPI will be

returned to provider (RTP)

Correcting Claim Errors in Consolo

Consolo checks claims to verify the NPIs and 9 digit Zip Codes are present. Claims display error

messages when the Facility NPI and 9 digit Zip Codes are missing. To correct errors, please Go

to the Services Tab, Edit the Facility and do the following:

Missing Facility NPI Number Error - Add the NPI Number

Missing Facility 9 Digit Zip Code Error – Add the 9 Digit Zip Code, then do the following:

Go to the Patient Home Page

Open the Change in Care Area

Edit/Save the Care Level Change so that the new Zip Code is displayed

Repair the Claim and Send

Note: To prevent Medicare Claim Rejections please ensure that the Facility Types defined

above contain a nine Digit Zip Code and an NPI. Prior to Creating Claims, Run the Active

Patient Summary Report to verify Zip Codes for the Facility Types listed above are 9 digits.

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Claim Sample

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Post Mortem Visit Details for Claims

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Post-Mortem Modifier (PM) |Populating on Claims Relating to CMS Change Release 8358

When charting for the Date of Death, Visits which span the time of death should be entered as

two separate visits so they may be reported separately on claims.

Details from CMS:

Report Visits that occur after Death and on Date of Death

Includes hospice-employed nurses, aides, social workers, and therapists

Regardless of level of care, or site of service

Billing requirements include:

Revenue code

HCPCS code

Modifier ‘PM’

Units (15-minute increments)

Charges

Service date

Visits subsequent to date of death are not reported

Sample from CMS

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Example of Post Mortem Process within Consolo – Creating Two Visits:

Discharge Due to Death is 2/05/2014 0800 - Visit starts at 0600 and ends at 1200

o Enter the Date and Time of Death in the Change in Care Screen

o Visit #1 - Enter one visit from 0600 to 0759

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Visit #2 - Enter the second visit from 0800 to 1200 (Visit must be on Date of Death, beginning

at Time of Death or after to be classified as Post Mortem on the Claim)

Clinical Chart Summary Screen

The first visit will not be labeled as Post-Mortem, but the second one will be classified as

Post Mortem on the Claim. To determine which visits are labeled as Post-Mortem on the

claim, the system will compare the Time In of the visit to the Effective Date/Time of the

Discharge Due to Death Change in Care Entry.

Notes:

o The “Time of Death” displayed inside the Discharge Tab of the Care Level Change

Screen is not used for Post Mortem Visits

o If the visit is on or after the Discharge Due to Death Date and Time, the visit will be

labeled with a PM modifier on the claim

o If the visit starts prior to the Discharge Due to Death Date and Time, it will look like

any other visit on the claim.

o Post Mortem Visits that pass midnight on the Date of Death should have a time out

of 11:59 and an additional entry should be created for the Day after Death, this visit

will not be included on the claim

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Post Mortem Reporting | Medicare Visit Summary Report

The Medicare Visit Summary Report will identify which visits are Post Mortem and this report

may be used to verify Post Mortem Visits are entered accurately prior to processing claims.

Post Mortem Visits may be identified from the Patient Clinical Charting Summary Page:

o Filter for Post Mortem = Yes

o Post Mortem Symbol

Claim Example: