April 1, 2010, Home Health & Hospice Medicare A Newsline - CGS

Additional InformationIf you have questions regarding this issue, refer to the “Contact Us” page of our Web site and select “PhoneUs” to call the Provider Contact Center.The official instruction, CR 6740, issued to Medicare MACs and carriers regarding this change may beviewed at http://www.cms.hhs.gov/Transmittals/downloads/R1875CP.pdf on the CMS Web site. Therelated MLN Matters article may be found athttp://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6740.pdf on the CMS Web site.Medicare manuals are available at http://www.cms.hhs.gov/Manuals/IOM/list.asp on the CMS Web site.MLN Matters® Number: SE1010 Related Change Request Number: 6740The E/M documentation guidelines are available athttp://www.cms.hhs.gov/MLNEdWebGuide/25_EMDOC.asp on the CMS Web site.DisclaimerThis article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article maycontain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be ageneral summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review thespecific statutes, regulations and other interpretive materials for a full and accurate statement of their contents. CPT onlycopyright 2009 American Medical Association.News from Cahaba for Home Health and Hospice ProvidersSuspended Claims—What You Need to KnowData analysis shows that providers often call the Provider Contact Centers (PCCs) with questions aboutclaims that are in a suspended status/location (S/LOC). These claims can be identified in the FiscalIntermediary Standard System (FISS) by the status code “S” (e.g., S B0100, S M50MR).All claims will temporarily suspend in different S/LOCs as they process through FISS, and generally,providers do not need to take action for claims in a suspended S/LOC. Suspended claims may requireMedicare staff intervention and could remain in a suspended S/LOC for about 30 days. In some casesclaims may require additional processing time. For example:• Claims with Medicare Secondary Payer (MSP) involvement may be suspended for more than 60 daysto complete investigation and processing.• Claims selected for prepayment review require action by the provider, and therefore; may take up to 60days to complete processing. Claims in prepayment review generate an Additional DevelopmentRequest (ADR) (FISS S/LOC “S B6001”) to which the provider must submit the requested medicalrecord documentation. For more information about claims in the ADR S/LOC “S B6001”, refer to the“Additional Development Request (ADR) Process” Web page located on Cahaba’s Web site.Home Health & Hospice April 1, 2010 31Medicare A Newsline Vol. 17, No. 7