Exploring the Direct Data Entry (DDE) Inquiries Menu December 2023 Disclaimer We prepared this education as a tool to assist the provider community. Medicare rules change often. They are in the relevant laws, regulations and rulings on the
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Presentation Transcript
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Exploring the Direct Data Entry (DDE) Inquiries Menu December 2023<br>
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Disclaimer We prepared this education as a tool to assist the provider community. Medicare rules change often. They are in the relevant laws, regulations and rulings on the Centers for Medicare & Medicaid Services (CMS) website.
We will provide responses to questions based on the facts given, but the Medicare rules will determine final coverage.
CMS prohibits recording of the presentation for profit-making purposes.<br>
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Acronyms ADR – Additional Development Request
ANSI – American National Standards Institute
CMS – Centers for Medicare & Medicaid Services
DDE – Direct Data Entry
DRG – Diagnosis Related Group
EFT – Electronic Funds Transfer
FISS – Fiscal Intermediary Standard System
HCPCS - Healthcare Common Procedure Coding System<br>
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More Acronyms MBI – Medicare Beneficiary Identifier
MSI – Multiple Services Indicator
POA – Present on Admission
PPS – Prospective Payment System
RA – Remittance Advice
RTP – Return(ed) to Provider
SC – Screen Control or Short Cut
TOB – Type of Bill<br>
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DDE Main Menu<br>
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01 - Inquiries<br>
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10 – Beneficiary/CWF Displays current Medicare Part A and Part B entitlement
Additional eligibility information
Benefit period
Current and prior
Deductible
Hospice
Home Health
Preventive services
Medicare Advantage<br>
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11 – DRG (Pricer/Grouper) Displays detailed payment information
Calculated by the Pricer and Grouper software programs
Provides specific Diagnostic Related Group (DRG) assignment
Prospective Payment System (PPS) payment calculations
Specific information required for accurate calculation<br>
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Data Required for DRG Inquiry Diagnosis and procedure codes
Including Present on Admission (POA) indicators
Discharge status code
Discharge date
Covered days
Total charges
Patient’s date of birth (or age)
Gender<br>
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12 – Claim Summary Displays history information for claims
Pending
Processed
Customize search by:
Medicare Beneficiary Identifier (MBI)
Type of Bill (TOB)
Status
Location
Claim From/To date<br>
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Claim Summary List<br>
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Claim Detail Select claim to view in entirety
F8 to move page by page
No updates
Inquiry only
F1 to view narrative of Reason Codes
Or 17 in Screen Control (SC) field
Reason Code sub-menu<br>
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Claim Page 1<br>
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Reason Code Narrative<br>
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Claim Page 2<br>
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Line-Item Detail<br>
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Claim Page 3<br>
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Claim Page 4<br>
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Claim Page 5<br>
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Claim Page 6<br>
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13 – Revenue Codes Revenue codes allowable on certain types of bills
View other revenue code requirements:
HCPCS
Units
Rate
Effective date
Termination date (if applicable)
Enter four digits in REV CD field
Zero in first position<br>
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14 – HCPC Codes View allowable revenue codes
Display rate data for HCPCS pricing
If multiple procedure payment reduction applies
Multiple Services Indicator (MSI) = 5
Required in addition to HCPCS:
Locality Code, or
Carrier and Locality Codes, or
Provider Number<br>
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16 – Adjustment Reason Codes Two-digit code and narrative
Identifies reason for adjustment
Supplements Claim Change Reason Code
More detailed information
Example: D1 – changes to charges
SA – increase in covered charges
SB – decrease in covered charges<br>
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17 – Reason Codes Narrative defines and gives instruction
Processing and adjudication information
Edit at claim or line level
Identifies status/location<br>
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56 – Claim Count Summary Total claim count and dollar amount by status/location<br>
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68 – ANSI Reason Codes View codes on Remittance Advice (RA)
American National Standards Institute (ANSI)
Research narrative and associated information<br>
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FI – Check History View three most current payments
Check or electronic funds transfer (EFT)
CHECK # field
Leading zeros indicate payment by check
Leading “eft” indicates electronic payment
Dates payments issued
Dollar amounts of payments<br>
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Locating the DDE Manual<br>
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Resources Direct Data Entry (DDE) Manual
Direct Data Entry (DDE) Overview<br>
