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ADVISORY 2004-08

SUBJECT: Revision of the TWCC-67 and TWCC-68

To ensure consistency with the Centers for Medicare and Medicaid Services (CMS) billing procedures, the Texas Workers' Compensation Commission (Commission) has revised the instruction pages for two medical billing forms:

  • DWC-67, Instructions for completing the CMS-1500, and
  • DWC-68, Instructions for completing the UB-92.

These changes provide instructions for the use of the CMS-1500 form for professional medical services as well as Ambulatory Surgical Center (ASC) services. To allow transition from the old TWCC-67 form dated 07-03, to the new form, most system participants may use the old TWCC-67 form through October 1, 2004. However, ASCs will be required to bill on the CMS-1500 completed in accordance with the new TWCC-67 for all services provided on or after September 1, 2004. The September 1, 2004 implementation date has been shared with system participants, including ASCs and carriers, through rule development processes and in numerous Commission educational seminars. This change maintains consistency with established CMS billing requirements to facilitate accurate reimbursement in accordance with the implementation of the Ambulatory Surgical Center Fee Guideline, Rule 134.402. This guideline requires system participants to apply the Medicare program reimbursement methodologies, models, and values or weights, including the coding, billing, and reporting payment policies effective on the date a service is provided. The ASC Fee Guideline requires the use of Healthcare Common Procedure Coding (HCPCs), which will be reported on the CMS-1500.

In addition, minor changes to these forms have been made to begin to align the processes with the Commission's Medical Implementation Guide for electronic medical billing data submission. For example, the provider type codes have been modified to ensure proper reporting of participant information. While additional changes to these forms are expected as the Commission continues to refine the electronic submission implementation guidelines, releasing new instruction forms is required with the adoption of the ASC billing process changes.

Signed this 26th day of August, 2004

Robert L. Shipe, Acting Executive Director


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