Providers are doing a pretty good job of billing with their own NPIs, but not so well for their referring physicians.
Most Medicare contractors report that more than 90 percent of claims are National Provider Identifier-compliant, the Centers for Medicare & Medicaid Services says.
But there are still NPI problems, and many of them involve the lack of an NPI in the secondary provider field, which is usually the referring physician's NPI for home care providers' claims. "We are seeing this particular issue rapidly improve as more and more providers realize the need for NPI-only in secondary identifier fields," CMS says.
Not all the NPI problems are providers' fault. Reason codes 32152 and 32159 were inappropriately applied to the secondary provider identifier due to issues with the physician file, reports the National Association for Home Care & Hospice.
But those issues have been resolved, says regional home health intermediary Cahaba GBA. • There's a new prospective payment system billing snafu to watch out for. "The clinical domain is inexplicably, and incorrectly, being downcoded on final claims when more therapy services are delivered and billed than projected on the request for anticipated payment (RAP)," NAHC reports.
This alleged error joins other existing problems such as the claims system's inability to count 2007 episodes when determining early or later episode sequence based on M0110. • Don't forget to use the new 855 enrollment form starting July 1, RHHI Cahaba GBA reminds providers. "Effective July 1, 2008, Cahaba will no longer accept applications on the old 2006 version of the CMS-855," the intermediary warns in a message to providers. More providers than ever before are using the 855 forms due to new reenrollment rules, fraud demonstration requirements and paperwork necessary for the PECOS transition (see Eli's HCW, Vol. XVII, No. 17). • CMS wants hospices to plan and budget for 2008, so it has released the hospice per beneficiary cap amount for the year: $22,386.15.
CMS has also furnished its methodology for computing the cap so that providers can do so for themselves for future years. Details are at
www.cms.hhs.gov/hospice/downloads/2008_Aggregate_Cap_Amount.pdf.
Hospice payments in excess of the caps were a topic of concern for the Medicare Payment Advisory Commission in discussing hospice payment reform this year (see Eli's HCW, Vol. XVII, No.11). CMS will issue a formal notice of the cap this summer, it says. • Home care providers furnishing Part B therapy will have to abide by the Part B therapy caps for all patients unless lawmakers intervene.
"On or after July 1, 2008, the exceptions to therapy caps are restricted to those medically necessary services billed by the outpatient departments of hospitals," Palmetto says on its Web site. "Use of the KX modifier will not be effective [...]
