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Home Health & Hospice Week

Industry Notes:

Outlier Claims Snafu Trips Up HHA Payments

Published on Thu Mar 24, 2011

HHAs are having trouble with some claims payment issues as well. For example: Agencies are experiencing problems with some outlier claims, Cahaba GBA says. "When Cahaba staff initiates an adjustment (type of bill 3XI) to a claim that originally paid with an outlier, the adjustment processes without the outlier payment," the RHHI says. And some Part A claims are seeing erroneous suspensions for claims categorized as duplicates, HHH MAC NHIC says. "Since the implementation of the April system release, claims are incorrectly suspending as duplicates (reason codes 38108, 38109, 39069, 36342)," NHIC explains. "Impacted claims are being held in Location SMDTLD." Agencies will have to hold on for a solution. But at least another system problem has been resolved, according to Cahaba. Some providers hadn't been able to access information on the Home Health Payment Totals Inquiry screen (Option 67). That left them unable to track their outlier payments and [...]
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