Prospective Payment System:
PAYMENT PROBLEMS PERSIST UNDER PPS CHANGES
Published on Thu Jan 17, 2008
Providers hold their breath as Medicare sorts out claims system glitches.
The cash flow gush providers were hoping for Jan. 14 may not have materialized, but Medicare is slowly starting to pay some 2008 claims.
In its Jan. 9 Open Door Forum, the Centers for Medicare & Medicaid Services identified problems with the new claims payment software required for the prospective payment system changes that took effect Jan. 1. And CMS laid out a timeline for resolution of those problems (see Eli's HCW, Vol. XVII, No. 2).
At the time of the forum, regional home health intermediaries were holding all 2008 claims. They were supposed to have a fix for general claims system problems by Jan. 11 and start processing 2008 requests for anticipated payment (RAPs) by Jan. 14, CMS' Wil Gehne said in the forum.
Software corrections for two specific problems, those related to rural Core-Based Statistical Area (CBSA) codes and HIPPS codes for claims straddling 2007-2008, were scheduled to go to RHHIs by Jan. 14, with claims processing by mid-week if the fixes worked. CMS was further investigating reported problems related to the new treatment authorization codes.
"CMS has to be pretty disappointed that after all the assurances by contractors that the new system had been testing out fine, that problems with this significant an impact were not detected," observes Bob Wardwell with the Visiting Nurse Associations of America. Wardwell headed up PPS' original implementation in 2000 as a top CMS official. What's Happening To Your Claims The intermediaries did receive the first software patch by Jan. 11, but didn't test it and start releasing RAPs until Jan. 15, reports the National Association for Home Care & Hospice.
CMS also has temporarily lifted the edit on the treatment authorization code so that claims affected by that problem could go through, according to NAHC. Intermediary Palmetto GBA reports on its Web site that those codes are indeed causing problems. It was using Reason Code 30720 to suspend affected claims to Status/Location SM0720 before the edit was lifted.
Still holding: At press time, the intermediaries hadn't started releasing RAPs and claims affected by the CBSA and HIPPS code problems. NAHC reports that claims with CBSA problems still won't be able to process for a while yet because the software patch for the CBSA error didn't work.
But a CMS official told Eli the fixes for those problems would go in Jan. 16 and intermediaries would release the RAPs and claims the same day.
At press time, billing software vendor Lewis Computer Services Inc. reported that not many 2008 RAPs from RHHIs Cahaba GBA, or former National Government Services segments United Government Services and Blue Cross of California have paid. Palmetto was doing a bit better with 28 percent of [...]
