instructions for completing report of patient services revenue diagnostic and treatment centers

How should patient care-related revenue be reported?

Patient care-related revenue should be reported net of adjustments for all third party payers, charity care adjustments, bad debt, and any other discounts or adjustments, as applicable when reporting patient care-related revenue sources.

Can reporting entities use budgeted revenues for provider relief fund payments?

Yes. When reporting use of Provider Relief Fund payments toward lost revenues attributable to coronavirus, Reporting Entities may use budgeted revenues if the budget (s) and associated documents covering calendar year 2020 were established and approved prior to March 27, 2020.

What does net patient services Revenue mean?

Net Patient Services Revenue. definition/assessability: In general, net patient services revenue shall mean all moneys received for or on account of hospital or medical services provided or related to patients whose purpose is the treatment or prevention of human illness, disease, injury or disability.

Are grants received from the Health Center program considered patient services revenue?

No. Grants awarded to Health Center Program-funded health centers and look-alikes are used to support specific operating costs of the FQHC, as approved by HRSA through the annual budgeting process, and are not considered to be patient services revenue. Therefore, such grants should not be factored into the lost revenues calculation.

Columnar Descriptions

Column A - Description: This column itemizes total net patient services revenue received, including surcharges.

Columnar Descriptions

Column A - Non-Direct Pay Payors: Provides specific line descriptions of non-direct pay payors.

Summary Lines

Line 14 - Total Assessable Revenue, including surcharges: Sum Column B, Lines 9 through 13. This amount must equal the amount reported in Column D, Line 8 of the corresponding service period report.

Hospital Inpatient and Outpatient Services

General hospitals issued an operating certificate pursuant to Article 28 of the Public Health Law (PHL) are required to submit reports electronically for reporting periods on and after January 1, 2005 by accessing the Web at: www.hcrapools.org.

Hospital Inpatient Services Report of Patient Services Revenue Received and Surcharge Obligations Insructions

Column A - Description. This column itemizes total net patient services revenue received, including surcharges.

Hospital Outpatient Services Report of Patient Services Revenue Received and Surcharge Obligations Instructions

Column A - Description: This column itemizes total net patient services revenue received, including surcharges.

Notes

Including, but not limited to, hospital based laboratory, clinic, and ambulatory surgery services.

Do commercial organizations that do not submit their audit through the Federal Audit Clearinghouse get an extension to the submission due date for their audit?

Yes. Both commercial organizations and non-federal entities are granted a six-month extension to the submission of audits that have a fiscal-year end through June 30, 2021. As a reminder, audits are due 30 calendar days after receipt of the audit report or nine months after the end of the audit period – whichever is earlier.

A non-profit corporation has multiple subsidiaries, including a for-profit subsidiary, that are consolidated for financial reporting purposes. Can the Single Audit of the non-profit corporation include the expenditures of federal awards of the for-profit subsidiary?

Yes, the non-profit corporation can include the expenditures of federal awards of its for-profit subsidiary in its Single Audit.

Can my organization get an extension to the submission due date for Single Audits conducted under 45 CFR Part 75?

Yes. As a reminder, audits are due 30 calendar days after receipt of the auditor report or nine months after the end of the audit period – whichever is earlier.

Will HHS release separate requirements for recipients of the Skilled Nursing Facility (SNF)and Nursing Home Infection Control Distribution payments?

No. HHS included requirements on how recipients of the SNF and Nursing Home Infection Control Distribution payments will report on these funds in the June 2021 Post-Payment Notice of Reporting Requirements.

Will HHS provide guidance to certified public accountants and those organizations that providers will rely on to perform audits?

The only guidance HHS provides to auditors is through the Office of Management and Budget Compliance Supplement.

Are Provider Relief Fund payments to commercial (for-profit) organizations subject to Single Audit in conformance with the requirements under 45 CFR 75 Subpart F?

Commercial organizations that expend $750,000 or more in annual awards have two options under 45 CFR 75.216 (d) and 75.501 (i): 1) a financial related audit of the award or awards conducted in accordance with Generally Accepted Government Auditing Standards; or 2) an audit in conformance with the requirements of 45 CFR 75.514 (Single Audit).

The Rural Health Clinic (RHC) COVID-19 Testing Program requires that recipients report payments received separately from the payment (s) received as part of the Provider Relief Fund. How do RHCs determine whether they received payment as part of the RHC COVID-19 Testing Program?

RHCs that were issued a payment with the descriptor “HHSPAYMENT” or “COVID*RuralHealthTestingPmt*HHS.GOV” on or around May 20, 2020, June 9, 2020, December 7, 2020, and/or January 20, 2021, received these payments as part of RHC COVID-19 Testing Program.

What is the CPT code for FDG PET?

Effective for claims with dates of service on or after April 3, 2009, contractors shall accept FDG PET claims billed to inform initial treatment strategy with the following CPT codes AND modifier PI: 78608, 78811, 78812, 78813, 78814, 78815, 78816.

What is the ICd 9 code for PET scan?

In order to pay claims for PET scans on behalf of beneficiaries participating in a CMS-approved clinical trial, A/B MACs (A) require providers to submit claims with, if ICD-9-CM is applicable, ICD-9 code V70.7; if ICD-10-CM is applicable, ICD-10 code Z00.6 in the primary/secondary diagnosis position using the ASC X12 837 institutional claim format or on Form CMS-1450, with the appropriate principal diagnosis code and an appropriate CPT code from section 60.3.1. Effective for PET scan claims for dates of service on or after January 28, 2005, through December 31, 2007, A/B MACs (A) shall accept claims with the QR, QV, or QA modifier on other than inpatient claims. Effective for services on or after January 1, 2008, through June 10, 2013, modifier Q0 replaced the-QR and QA modifier, modifier Q1 replaced the QV modifier. Modifier Q0/Q1 is no longer required for services performed on or after June 11, 2013.

What is a PET scan?

Effective for services on or after January 28, 2005, contractors shall accept and pay for claims for Positron Emission Tomography (PET) scans for lung cancer, esophageal cancer, colorectal cancer, lymphoma, melanoma, head & neck cancer, breast cancer, thyroid cancer, soft tissue sarcoma, brain cancer, ovarian cancer, pancreatic cancer, small cell lung cancer, and testicular cancer, as well as for neurodegenerative diseases and all other cancer indications not previously mentioned in this chapter, if these scans were performed as part of a Centers for Medicare & Medicaid (CMS)-approved clinical trial. (See Pub. 100-03, National Coverage Determinations (NCD) Manual, sections 220.6.13 and 220.6.17.)

What is the ASC X12 837?

Claims for PET scan services must be billed using the ASC X12 837 professional claim format or on Form-CMS 1500 with the appropriate HCPCS or CPT code and diagnosis codes to the A/B MAC (B). Effective for claims received on or after July 1, 2001, PET modifiers were discontinued and are no longer a claims processing requirement for PET scan claims. Therefore, July 1, 2001, and after the MSN messages regarding the use of PET modifiers can be discontinued. The type of service (TOS) for the new PET scan procedure codes is TOS 4, Diagnostic Radiology. Payment is based on the Medicare Physician Fee Schedule.

How is Medicare payment based on locality?

The payment locality is determined based on the location where a specific service code was furnished. For purposes of determining the appropriate payment locality, CMS requires that the address, including the ZIP code for each service code be included on the claim form in order to determine the appropriate payment locality. The location in which the service code was furnished is entered on the ASC X12 837 professional claim format or in Item 32 on the paper claim Form CMS 1500. Global Service Code

What is the CPT code for nuclear medicine?

The TC RVUs for nuclear medicine procedures (CPT codes 78XXX for diagnostic nuclear medicine, and codes 79XXX for therapeutic nuclear medicine) do not include the radionuclide used in connection with the procedure. These substances are separately billed under codes A4641 and A4642 for diagnostic procedures, and code 79900 for therapeutic procedures and are paid on a “By Report” basis depending on the substance used. In addition, CPT code 79900 is separately payable in connection with certain clinical brachytherapy procedures. (See §70.4 for brachytherapy procedures).

How much iodine is in a low osmolar contrast material?

Supply of low osmolar contrast material (100-199 mgs of iodine); Supply of low osmolar contrast material (200-299 mgs of iodine); or Supply of low osmolar contrast material (300-399 mgs of iodine).

60-Day Grace Period – Reporting Period 1

The September 30, 2021 Reporting Period 1 deadline has not changed, however in response to challenges providers are facing given the Covid surges and natural disasters around the country a 60-day Grace Period is in place.

Step 1: Register in the Provider Relief Fund Reporting Portal

The PRF Reporting Portal is open for recipients who received one or more payments exceeding, in the aggregate, $10,000 during Payment Received Period 1 (April 10, 2020 to June 30, 2020).

Step 2: Read the Reporting Requirements Notice

The Post-Payment Notice of Reporting Requirements updated on June 11, 2021 provides details on how to report on the use of funds. This supersedes all previous Notices of Reporting Requirements. Read the Reporting Requirements Notice (PDF - 232 KB) and reference the Reporting and Auditing Frequently Asked Questions.

Step 3: Complete and Submit Your Report

Complete and submit your report via the Provider Relief Fund Reporting Portal.

Important Dates for Reporting

Recipients who received one or more payments exceeding $10,000, in the aggregate, during a Payment Received Period are required to report in each applicable Reporting Time Period as outlined in the table below.

Need Help With Reporting?

We have detailed answers to common questions related to reporting requirements and auditing. Read the Frequently Asked Questions.

Partial Return of Funds

Once the report has been filed, the provider must return any unused funds to the government within 30 calendar days after the end of the applicable Reporting Time Period, as explained in the Terms and Conditions, and the Reporting Requirements Notice (PDF - 201 KB) (June 11, 2021).

What is MBC billing?

MedicalBillersandCoders (MBC) systematically connects diagnosis and procedural codes ensuring timely payments from insurance carriers. To know more about our medical coding and billing services you contact us at 888-357-3226 / info@medicalbillersandcoders.com.

What is the ICd 10 code for health?

The Factors Influencing Health Status and Contact with Health Services codes (Z00-Z99) are provided to deal with occasions when circumstances other than a disease or injury are recorded as diagnosis or problems.

What is a first listed diagnosis?

In the outpatient setting, the term first-listed diagnosis is used in lieu of principal diagnosis. In determining the first-listed diagnosis the coding conventions of ICD-10 -CM, as well as the general and disease-specific guidelines take precedence over the Outpatient Services guidelines.

What are the characters in ICd 10?

ICD-10-CM codes with 3, 4, 5, 6 or 7 characters: ICD-10-CM is composed of codes with 3, 4, 5, 6 or 7 characters. Codes with three characters are included in ICD-10-CM as the heading of a category of codes that may be further subdivided by the use of fourth, fifth, sixth or seventh characters to provide greater specificity.#N#Use of the full number of characters required for a code: A three-character code is to be used only if it is not further subdivided. A code is invalid if it has not been coded to the full number of characters required for that code, including the 7th character, if applicable.

What is diagnosis code?

The diagnosis code supports the medical necessity for the service and tells the payer why the service was performed. It can be the source of denial if it doesn’t show the medical necessity for the service performed.

What is the Z00.0 encounter?

The subcategories for encounters for general medical examinations, Z00.0- and encounter for routine child health examination, Z00.12-, provide codes for with and without abnormal findings. Should a general medical examination result in an abnormal finding, the code for general medical examination with abnormal findings should be assigned as the first-listed diagnosis. An examination with abnormal findings refers to a condition/diagnosis that is newly identified or a change in the severity of a chronic condition (such as uncontrolled hypertension, or an acute exacerbation of chronic obstructive pulmonary disease) during a routine physical examination. A secondary code for abnormal findings should also be coded.

When a patient presents for outpatient surgery (same day surgery), code the reason for the surgery as the

When a patient presents for outpatient surgery (same-day surgery), code the reason for the surgery as the first-listed diagnosis (the reason for the encounter), even if the surgery is not performed due to a contraindication.