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

More documents

Recommendations

Info

Field DescriptionsThe following provides field descriptions for the Home Health Payment Totals Inquiry (Map 1B41) andthe Home Health Payment Totals Detail (Map 1B42) screens.Home Health Payment Totals Inquiry (Map 1B41) Field DescriptionsPROVIDERNPISELYEAROUTLIERTOTALPAYMENTTOTALYour Provider Transaction Access Number (PTAN) (also known as yourOSCAR/Legacy provider number).Your facility’s National Provider Identifier (NPI) numberSelection. This field is used to view claim data for a particular year.The calendar year in which the outlier and payment totals are comprised.The total outlier payments made on HH PPS home health claims for a calendaryear. Note that Requests for Anticipated Payment (RAPs), (type of bills 322 or332), are excluded from this total. The “TO” date on the HH PPS claimdetermines the calendar year in which the outlier is applied.The total HH PPS payment made on home health claims for a calendar year. Notethat Requests for Anticipated Payment (RAPs), (type of bills 322 or 332), areexcluded from this total. The “TO” date on the HH PPS claim determines thecalendar year in which the outlier is applied.Home Health Payment Totals Detail (Map 1B42) Field DescriptionsPROVIDERNPIYEARDATEHIC NUMBERDCNVALUE CD 17VALUE CD 64VALUE CD 65Your Provider Transaction Access Number (PTAN) (also known as yourOSCAR/Legacy provider number).Your facility’s National Provider Identifier (NPI) numberThe calendar year that was selected to view the claim detail data.The month and day of the “through” date of the claim.The beneficiary’s Health Insurance Claim number on the claim.The document control number of the claim.The dollar amount associated with the outlier payment on the claim.The dollar amount associated with the HH PPS payment from the Part A trustfund. For more information regarding the Medicare Part A trust fund, see theMedicare Claims Processing Manual (Pub. 100-4, Ch. 10, § 10.1.10.4)The dollar amount associated with the HH PPS payment from the Part B trustfund. For more information regarding the Medicare Part B trust fund, see theMedicare Claims Processing Manual (Pub. 100-4, Ch. 10, § 10.1.10.4)Home Health & Hospice April 1, 2010 43Medicare A Newsline Vol. 17, No. 7
Resolving Reason Code U538FThe Cahaba Customer Service Representatives (CSRs) are reporting increased questions from home healthproviders regarding Requests for Anticipated Payment (RAPs) and final claims that are returned to provider(RTP) for correction for reason code U538F. This edit fires when a RAP or final claim overlaps an existingepisode with the same provider number and the “FROM” date equals the episode’s start date OR a visit dateon a final claim falls within another episode established by another home health agency (HHA) or thebilling HHA.HHAs receive this error most often when they submit a second RAP for an episode where the final claim forthe same episode was previously submitted and rejected (FISS status/location (S/LOC) R B9997).Example: An HHA submits a RAP and final claim for an episode from 08/30/09 to 10/28/09. The finalclaim rejects to S/LOC R B9997. The HHA submits a second RAP for 08/30/09 – 08/30/09, which is sentto RTP (T B9997) with reason code U538F.Billing errors for this reason code may also occur when a home health agency submits a final claim and itcontains a visit date (line item date of service – LIDOS) that overlaps another HHA’s episode or the billingprovider’s subsequent episode. Example: ABC Home Care submits a final claim for episode 02/01/09 –04/01/09, which contains a LIDOS for 02/24/09; however, XYZ Home Care has already established anepisode from 02/03/09 to 04/03/09, which is posted to Common Working File (CWF) for the beneficiary.How to prevent/resolve:• Submit only one RAP and final claim for each episode of care. If the final claim for the episode rejects,do not submit a second RAP. The final claim will need to be adjusted or resubmitted. See the“Resolving Rejected Home Health Claims Caused by Billing Errors” Web page for assistance indetermining whether to adjust or resubmit a rejected home health final claim.• Prior to admission or submitting RAPs/claims to Medicare, access ELGH page 3 or ELGA page 4 toreview established episodes for beneficiary, which may impact your dates of service. See the“Additional Resources” below for instructions on accessing the beneficiary eligibility screens ELGHand ELGA.• Tip: You may need to use the APP DATE field to research older episodes.• If another HHA’s episode overlaps your dates of service AND you are disputing their episode, you mustfollow the instructions for resolving a transfer dispute prior to contacting Cahaba for assistance. Alsoreview the information regarding beneficiary elected home health transfers.• If another HHA’s episode overlaps your dates of service AND there is NO dispute regarding the dates ofservice, remove the overlapping dates from your claim. Instructions for deleting revenue lines areaccessible for the “Claims Correction” section of the FISS Reference Guide.Additional Resources• Checking Beneficiary Eligibility section of the FISS Reference Guide• Inquiry Menu section of the FISS Reference Guide• Resolving Rejected Home Health Claims Caused by Billing Errors quick reference toolHome Health & Hospice April 1, 2010 44Medicare A Newsline Vol. 17, No. 7
Page 1 and 2: Home Health & HospiceMedicare A New
Page 3 and 4: H1N1 Influenza ImmunizationsMedicar
Page 5 and 6: Revised Medicare Physician Fee Sche
Page 7 and 8: classified (NOC) drug pricing files
Page 9 and 10: DisclaimerThis article was prepared
Page 11 and 12: BCTransfer From AnotherHome Health
Page 13 and 14: BackgroundWhen the National Uniform
Page 15 and 16: Key OPPS Updates for April 20101. P
Page 17 and 18: carrier or A/B MAC cannot provide a
Page 19 and 20: Note: Medicare contractors may adju
Page 21 and 22: Additional InformationFor complete
Page 23 and 24: Implementation of Home Health Agenc
Page 25 and 26: Provider Types AffectedThis article
Page 27 and 28: A. CMS has alerted MAC audit staff
Page 29 and 30: interpretation is billed and no E/M
Page 31 and 32: The provider may not bill the patie
Page 33 and 34: Claims in the “S MXXXX” status/
Page 35 and 36: In addition, the provider will also
Page 37 and 38: For more detailed information about
Page 39 and 40: Can Cahaba provide guidance to us r
Page 41 and 42: Medicare Credit Balance Quarterly R
Page 43: MAP1B41 CAHABA GBA - RHHI ACPFAT01
Page 47 and 48: A2. Yes, you are correct. The langu
Page 49 and 50: medical director of the hospice or
Page 51 and 52: Cahaba GBA Learning Corner‣ “Cl

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

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?