Prospective Payment System:
CLAIMS SYSTEM FIX CLEARS UP NAGGING PPS PROBLEMS
Published on Mon Jan 07, 2008
But more issues are still hanging up some PPS claims.
Claims that span the calendar years could still be delaying your reimbursement under the prospective payment system revisions that took effect Jan. 1.
When you submit a final claim for an episode that started in 2007 with a pre-refinements HIPPS code, but the claim has a line item date of service of Jan. 1 or after, the system is returning to provider (RTP'ing) the claim with reason code 32403, regional home health intermediary Cahaba GBA explains in a Feb. 5 email to providers.
Cahaba has reported the error to the system maintainer, it says in the email. Meanwhile, you can find the RTP'd claims at status/location S M3240 for the intermediary.
But the software update that the Centers for Medicare & Medicaid Services scheduled for Feb. 4 went in successfully and cleared up many nagging PPS problems, Cahaba reports. The laundry list of previously announced problems that the fix solved include: • Failing to auto-adjust claims that had the wrong first HIPPS code digit for episode sequence or a lower therapy HIPPS code indicator when the patient actually received 20 or more visits (see Eli's HCW, Vol. XVII, No. 5); • Erroneously adding Nonroutine Supplies (NRS) payments to 2007 claims; • Returning claims when the fifth digit of the HIPPS code didn't match on the RAP and claim; and • Failing to wage-adjust the NRS add-on for low utilization payment adjustments (LUPAs). Providers won't need to take action on any claims processed incorrectly due to these problems, Cahaba advises.
Tip: Even though the edits for NRS won't start until April, Cahaba urges you to begin reporting supplies accurately on claims now. The system will check whether the claim has NRS line items if the fifth digit of the HIPPS code indicates (with a letter) that you furnished supplies in the episode.
Keep Track Of Your LUPAs Home health agencies will have to wait a while longer before they see relief on another previously announced PPS glitch, however.
CMS has issued marching orders to fix the problem in which the system awards the LUPA add-on, which is only supposed to go to a patient's lone or first episode, to a second episode if the patient is discharged from one agency and admitted to another within 60 days (see Eli's HCW, Vol. XVI, No. 40).
Summer deadline: The system correction won't take place until July 7, confirms Feb. 1 Transmit-tal No. 1424 (CR 5877). In the meantime, industry experts recommend you keep track of your LUPA overpayments, which will rack up at $87.93 per incorrectly paid episode.
The National Association for Home Care & Hospice counsels holding the overpayments in reserve for repayment.
The transmittal also contains corrections to its PPS billing [...]
