Intermediary offers solution for erroneously inactivated RAPs.
A claims system mix-up may be holding up your home health agency payments, but you can fix it with some intermediaries.
Problems began when claims, including requests for anticipated payment (RAPs), in location status PB9997 (Paid/Processed), DB9997 (Denied), RB9997 (Rejected) and TB9997 (Returned to Provider) were moved to IB9997 (Inactivated) location status. The claims had paid and showed up on remittance advices, but then moved to the inactivated location, regional home health intermediary Palmetto GBA explains on its Web site.
A RAP in the inactive location means your final claim for that episode will Return to Provider (RTP) due to there being no matching RAP, RHHI Cahaba GBA says in a post to its Web site.
Try this: Cahaba advises agencies to search for the missing RAP if a claim is RTP'd with reason code 38107. "If the RAP is in [Inactive] status/location PB9997 and has not been auto-canceled, access the claim from your RTP file, and press F9 to allow the claim to continue processing," the intermediary tells HHAs.
If the RAP has been auto-canceled or is not there for some other reason, resubmit the RAP and F9 the corresponding claim to start it processing again, Cahaba instructs.
More information is at
www.cahabagba.com/part_a/whats_new/20070216_claims.htm. • Don't miss this federal update if you're a supplier of durable medical equipment. On Feb. 23, the Centers for Medicare & Medicaid Services published a revised version of the general Advance Beneficiary Notice (CMS-R-131).
Public comments are requested during the 60-day comment period and will be considered as part of finalizing the revised ABN, federal officials note.
To view the Federal Register announcement and requirements for submitting comments, go to
www.gpoaccess.gov/fr/advanced.html. On this page, under "Search by Issue Date," select "Specific Date," select "On" and enter "02/23/2007." After "Search:" in the next line, enter "CMS-R-131".
To obtain copies of the ABN and supporting documents, go online to
www.cms.hhs.gov/PaperworkReductionActof1995.
• Medicare contractors should process "other-than-clean" claims within 45 days, CMS says in Transmittal 1173 (CR 5355). These claims require "investigation or development" outside of the contractor's Medicare operation on a prepayment basis.
If the contractor sends the provider a request for additional information five days after receiving the claim, the contractor will only have 40 days left to finish processing the claim and notify the provider of the result, CMS adds.
But the 45-day clock stops when the contractor sends the development letter and resumes when the carrier receives a response, CMS explains. "Other-than-clean" claims don't include those that have been delayed by a glitch in the Common Working File (CWF).
The transmittal is online at
www.cms.hhs.gov/transmittals/downloads/R1173CP.pdf. • Systems at Palmetto GBA fouled up, causing the contractor to start collecting overpayments through the [...]
