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Medical Data Call News

OK Flag

Reporting Updates

In Oklahoma, prior to July 1, 2020, the maximum reimbursement for hospital outpatient and ambulatory surgical services (ASC) was based on the maximum reimbursement for hospital inpatient services. Because of this reimbursement structure, outpatient and ASC services have often been reported in the Medical Data Call with MS-DRG (Medicare Severity Diagnosis Related Groups) codes, similar to inpatient services.

Beginning July 1, 2020, the underlying structure of the fee schedule in Oklahoma has changed. The maximum reimbursement for hospital outpatient and ASC services is now based on Medicare’s Outpatient Prospective Payment System. Under this new reimbursement structure, the maximum reimbursement for hospital outpatient and ASC services are based on CPT Codes, HCPCS Codes, and/or APC codes.

Preview of 2021 Financial Data Reporting Season

In June 2020, NCCI announced changes for the 2021 Financial Call reporting season for Calls valued as of December 31, 2020. Here is a summary of the changes for the upcoming season:

  • Changes to Call #19—Accident Year Countrywide Loss Adjustment Expense
  • Claim Number for Calls #31—Large Loss and Catastrophe and #33—Virginia Coal Mine Large Loss Catastrophe will be limited to 12 characters for policies effective January 1, 2020, and later
  • Extraordinary Loss Event (ELE) Catastrophe Number 12 for Calls #31 and #33
  • Calls with one or more critical edits will reject to improve the timeliness and quality of data prior to submission
  • Any experience and premium effects associated with payments allocated to paid furloughed employees must be excluded from all Calls and valuations
  • Previous versions of the Electronic Import Template will be eliminated
Reporting Season

The following resources will be provided to keep you informed of changes included in the 2021 Financial Call Season:

Circular CALLS-2020-01—2021 Financial Call Season Reporting Changes, provides the latest information on the upcoming season. Look for more communication in the coming months.

Third Quarter 2020

  • Additional communication on reporting changes
  • Release of Data Quality Guidebook with any Aggregate Data Quality Incentive Program impact

Fourth Quarter 2020

  • Release of the updated Financial Call Reporting Guidebook
  • Details of new edits via Financial Call Edit Matrix

Data Reporting Learning Opportunities

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Learning Opportunities