Geographic Region Maintenance

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Each facility where patient services are rendered falls within a geographic region defined by the Centers for Medicare and Medicaid (CMS). Geographic regions affect claims in several ways:

  • By using geographic regions, ClaimStaker can apply the calculations needed for the RVU sequencing edit and ensure that all charges subject to multiple procedure payment rules are sequenced for highest reimbursement.

  • Medicare jurisdictions and specific Medicare payers are also identified by geographic region. Using geographic regions allows ClaimStaker to determine which local coverage determination (LCD) policies to use for medical necessity edits.

ClaimStaker allows you to set up the default geographic region for your organization that will be used when performing claim scrubs. Because some organizations have facilities in different geographic regions, ClaimStaker also allows for the use of as many additional geographic regions as needed. This allows individual facilities to scrub claims based on the zip code where they are located.

To manage geographic regions, select Configuration, then Geographic Region Maintenance, from the ClaimStaker toolbar. This opens the Medicare Geographic Region Maintenance page.

Changing a default geographic region

Your list of geographic regions will always contain a default geographic region. It cannot be deleted, it can only be changed. Your default geographic region is indicated by a check mark in the Default Region column in your list of geographic regions. To change your default geographic region:

  1. Select the icon under the Edit column for the default geographic region.

    Screenshot of the Geographic Region table on the Geographic Region Maintenance page. The table has six columns (Default Region, Facility Name, Georgraphic Region, Facility Zip Code, Edit, and Delete) and one row. Region 09102: Florida - all other counties is under the Geographic Region Column, and the check box under the Edit column is being selected.

  2. You are presented with a Geographic Region drop-down field. Select the new default geographic region and select the Apply button to save your change.

    3. Screenshot of the Default Region section. In the Geographic Region drop-down field, 09102: Florida - St. Lucie has been selected. The Apply button is being selected.

  3. A message confirms the change was successful and the new default geographic region displays in your list of geographic regions.

Setting geographic regions for multiple facilities

There are two ways to use geographic regions when scrubbing claims:

  1. Use the automatic geographic region option – Select the automatic geographic region selection option in the Other Settings section of the Medicare Geographic Region Maintenance page. This will cause ClaimStaker to perform scrubs using the facility zip code within each claim.

    Screenshot of the Other Settings section. The check box, Use service facility zip code from claim to automatically set geographic Jurisdiction for medical necessity, is selected.

  2. Set up geographic regions – You can also add each geographic region to be used by your organization in the Facility Details section of the page. To add a new geographic region for a facility, enter the facility's name (if desired for end user identification purposes), select the geographic region, and enter the five- or nine-digit zip code (numbers only). Select the Add button.

    Screenshot of the Facility Details section, which has three fields. The Facility Name field is blank. The Geographic Region drop-down field has 09102: Florida - All Other Counties selected. The Facility Zip Code field has 39235 entered. The Add button is being selected.

  3. After the facility is added, you are presented with a confirmation message and the new facility appears in your list of geographic regions.

    Screenshot of the Geographic Region table. The Geographic Region column has Region 09102: Florida - St. Lucie under the first column and 09102 - Florida - All Other Counties in the second row. The Facility Zip Code column has a blank first row and 39235 in the second row.

Editing a facility's geographic region

  1. If you are not using the automatic geographic region option and need to edit a specific facility's geographic region, select the icon for the facility under the Edit column.

    Screenshot of the Default Geographic Region table. The icon under the Edit column is being selected for 09102: Florida - All Other Counties under the Geographic Region column.

  2. Next, under the Default Region section, you can make the desired changes to the facility's geographic region. Select the Apply button when done.

    Screenshot of the Facility Details section. The Facility Name field has Example Doctor's Office entered. The Geographic Region field has 09102: Florida - All Other Counties selected. The Facility Zip Code field has 39235 entered.

  3. A message appears stating the geographic region has been successfully changed and the changes appear in your list of geographic regions.

Deleting a facility's geographic region

  1. To delete a specific facility's geographic region, select the icon in the Delete column for the geographic region to be deleted.

  2. Select the OK button to confirm deletion when prompted.

    3. Screenshot of the Geographic Region table. The icon under the Delete column is being selected for 00590: Florida - All Other Counties. Screenshot of the Geographic Region table. The Geographic Region column has Region 09102: Florida - St. Lucie under the first column and 09102 - Florida - All Other Counties in the second row. The Facility Zip Code column has a blank first row and 39235 in the second row. The icont under the Delete column is being selected.

  3. You are presented with a message stating that the facility's geographic region has been deleted and the facility no longer appears in your list of geographic regions.

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