Industry Notes:
BEWARE NEW PPS BILLING GLITCHES
Published on Mon Jan 14, 2008
Keep an eye out for cash flow threats.
If you're still submitting claims that span the calendar years, you might run into reimbursement roadblocks.
"RAPs and Final Claims with 'from' dates for service in 2007 spanning into 2008 are being returned to the provider (RTP) with reason code 32403," reports regional home health intermediary Palmetto GBA on its Web site. "RAPs and Final Claims are RTPing back to the provider in error."
Look closely: But a returned claim with reason code 32403 isn't always the claims system's mistake, Palmetto notes. If you have a claim that uses the wrong year's HIPPS code, it will RTP correctly.
Example: If your claim has a from date in 2007 and a thru date in 2008 and the claim includes a 2008 HIPPS code, it's "not a system problem," Palmetto explains.
But if your claim uses the correct year's HIPPS code and still gets returned, it's due to the system'S glitch. For instance, if the claim has a from date in 2007, a thru date in 2008, a first billable visit in 2008 and a 2007 HIPPS code, the system will reject it in error, Palmetto says.
Palmetto has reported the problem, but "there is no estimated time on when this fix will go into place," the intermediary says.
Meanwhile, the Centers for Medicare & Medicaid Services has fixed another nagging problem. The system was incorrectly recouping RAPs when paying final claims, reports the National Association for Home Care & Hospice. Home health agencies served by Palmetto and National Government Services complained to NAHC about the problem, the trade group says.
History: The same RAP recouping problem occurred in 2006 and 2007, NAHC points out.
A fix put into place over the weekend of Feb. 10 should have solved the problem, CMS tells NAHC.
CMS also reissued the PPS refinement and rate update transmittal for calendar year 2008. The transmittal now specifies that CMS will issue payment rates annually in a "recurring update notification instruction," according to Feb. 7 Transmittal No. 1443 (CR 5879). • Get ready to defend your claims for hypertension patients with long stays. RHHI Cahaba GBA is initiating a "continuing widespread review" of patients with a hypertension diagnosis in their third or later episode, the intermediary says on its Web site.
Top reason: In a widespread probe review on the topic, Cahaba medical reviewers denied 86 percent of claims reviewed. "The most problematic issue ... was that the documentation for the skilled nurse visits did not support medical necessity," Cahaba says.
HHAs shouldn't expect observation and assessment visits to hold up without supporting documentation. Observation and assessment are reasonable and necessary "when the likelihood of change in a patient's condition requires a skilled nurse to identify and evaluate the patient's need [...]
