Medical Data Call News
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
The following resources will be provided to keep you informed of changes included in the 2021 Financial Call
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
Webinars on Demand—These online training modules allow customers to access valuable training at their convenience.