Home Health & Hospice Week

New NPI requirement delays payments.

When you fail to include your zip code on your Medicare claims, expect to take longer to obtain payment.

A National Provider Identifier requirement to include your zip code on all billing transactions took effect Jan. 1, regional home health intermediary Cahaba GBA says on its Web site. For bills including RAPs, "providers must report a five- or nine-digit zip code for their primary facility and its subparts," Cahaba instructs.

Claims without the zip codes will be returned to provider (RTP'd) with reason code 32114, Cahaba notes. Home health agencies served by Palmetto GBA will see the claims held in location SMTECH, the intermediary says on its Web site.

Many providers were unaware of the new requirement, Cahaba says. "A large amount of billing transactions have suspended with reason code 32114."

Oops: That may be because the system applied the edit in error to 2006 claims as well. "The reason code was set to edit on any claim received on or after 1/1/07," RHHI United Government Services says on its Web site. "This was incorrect. It should have been coded to set on claims with service dates on or after 1/1/07" (emphasis added).

"A temporary workaround has been developed," UGS announces. "Providers that have had claims with 2006 service dates returned to them in error should resubmit the claims," the intermediary instructs.

Tip: Report the zip code of your primary facility and its subparts, not your billing facility, Cahaba says.

Another delay: HHAs served by Palmetto may also be seeing another claims hold-up. "Home Health and Hospice claims with service dates 01/01/07 and after will be held in location SMRHHI until the rate changes can be verified," Palmetto says on its site. • President Bush signed H.R. 6111, the Tax Relief and Health Care Act of 2006, into law Dec. 20. The law leaves the home health, hospice and oxygen payment rates intact, extends the therapy cap exception process, expands the Recovery Audit Contractor program to all states and requires a Medicare Payment Advisory Commission report on wage index (see Eli's HCW, Vol. XV, No. 45). • RHHIs Associated Hospital Service of Maine and United Government Services and durable medical equipment regional carrier AdminaStar Federal are merging under one parent organization. AHS, UGS and AdminaStar became National Government Services effective Jan. 1, according to releases from the intermediaries. NGS combines the operational, financial and human resources of AHS, UGS, Admina-Star, Anthem Health Plans of New Hampshire and Empire Medicare Services.

NGS will be the Medicare RHHI for: Alaska, Arizona, California, Connecticut, Hawaii, Idaho, Maine, Massachusetts, Michigan, Minnesota, Nevada, New Hampshire, New Jersey, New York, Oregon, Rhode Island, Vermont, Washington and the U.S. Territories of American Samoa, Guam, Northern Mariana Islands, Puerto Rico, and U.S. [...]