Check your claims data carefully.
You could prevent holdups to your cash flow by avoiding simple date problems.
Four of home health agencies' top submission errors involve incorrect dates on claims, says regional home health intermediary Palmetto GBA in its new review of the top 10 submission errors from October 2007.
Reason code 31755 occurs when the From, Thru and 0023 line item dates don't agree. For example, if the From and Thru date are the same, the 0023 date must also match, Palmetto explains.
Reason code 31018 shows up when your claim tries to make the patient's prospective payment system episode greater than 60 days. You can verify the episode dates through HIQH, Palmetto advises.
HHAs see reason code U5386 when the line item date doesn't fall within the 60-day episode. This is often due to a canceled request for anticipated payment (RAP), the intermediary points out.
Reason code 32907 is a similar problem, noting the requirement for line item services to fall within the 60-day period. Other top submission errors included trying to submit final claims when no RAPs for the episodes exist (38107); the now-defunct M0175-related incorrect HIPPS code based on prior inpatient stay (C727); incorrect beneficiary information (T5052 and N5052) and missing units for required revenue codes (32226).
For more on the top submission errors and ways to avoid or solve them, see
www.palmettogba.com or email editor Rebecca Johnson with "Top Submission Errors" in the subject line. • Oxygen suppliers may have a little less claims trouble than they expected from a new requirement. Last November, the Centers for Medicare & Medicaid Services established pre-payment autodenial edits for oxygen suppliers, the agency says in April 18 Transmittal No. 1493 (CR 5929).
The National Supplier Clearinghouse is supposed to "assign an oxygen specialty code to all suppliers who have indicated they will be providing oxygen and/or oxygen related services on their CMS 855S enrollment application," CMS explains in the transmittal. Then DME MACs are supposed to "edit claims to look for the oxygen specialty code and submit a quarterly report of oxygen and/or oxygen related equipment DMEPOS supplier false claim submission attempts to CMS."
Then "the NSC shall research the reported DMEPOS suppliers," CMS says.
Maybe not you: But the NSC will actually assign the codes only to suppliers in the 38 states that license or certify them for oxygen provision.
And the DME MACs now aren't editing for the specialty codes, CMS says in a new MLN Mat-ters Article (5929). "DME MACs are currently processing [oxygen] claims from enrolled and approved DMEPOS suppliers without regard to the specialty identified and services to be provided on the enrollment application form (CMS-855S)," CMS says.
The transmittal is at
www.cms.hhs.gov/MLNMattersArticles/downloads/MM5929.pdf. The article is at
www.cms.hhs.gov/MLNMattersArticles/downloads/MM5929.pdf. [...]
