Prospective Payment System:
TROUBLESHOOT PPS BILLING PROBLEMS BEFORE IT'S TOO LATE
Published on Mon Jan 28, 2008
Next Medicare claims processing software fix is due Feb. 4.
Prospective payment system claims from 2008 finally have a green light, but if you're still not getting paid, you're not alone.
Home health PPS requests for anticipated payment and claims should be processing now, a Centers for Medicare & Medicaid Services source tells Eli.
"The claims problems are all but gone," cheers Baton Rouge, LA-based software vendor Lewis Computer Services Inc. "Cash flow is restored for the most part," reports Bob Wardwell with the Visiting Nurse Associations of America.
"The worst of it is over," agrees William Dombi, vice president for law with the National Association for Home Care & Hospice. PPS claims from 2008 should go through and intermediaries are clearing their backlog of held claims.
Impact: Agencies that saw 100 percent of their 2008 RAPs and many final claims returned or held saw some serious consequences, Dombi notes. Some providers couldn't meet payroll and had to ask staff to hold on until cash came through. Others stopped taking new admissions until their claims started processing.
"We hope those patients found home care with other providers," but there's no way to know for sure, Dombi tells Eli.
Still more agencies tapped their lines of credit to stay afloat, which will cost them in financing fees. Some HHAs succeeded in obtaining accelerated payments from Medicare, but many were discouraged from even applying for the payments by intermediary staff, Dombi relates.
Even agencies that weren't strapped for cash had to put in extra man-hours trying to figure out what was happening with their claims.
The good news: "No one closed," Dombi says. Nailing Down Billing Errors Proves Tricky Despite the "all clear" on claims from CMS, many providers still aren't seeing all of their cash--and sometimes any cash at all--coming in, industry experts report.
"Not everyone is getting what they should yet," Dombi notes.
"Some agencies aren't getting paid and it's hard to know why," says billing expert Bobby Dusek in Abilene, TX. "They are trying to figure it out."
The hold-up could be occurring anywhere along the billing chain--in the provider's software or claims data entry, the submission process or Medicare's claims processing, Dusek points out. Pinpointing the exact reason can be frustrating for agencies.
"Now that the bigger problems are taken care of, smaller problems are surfacing," Dombi observes. And whether those problems lie with Medicare or the provider is up for grabs.
A few new claims system problems have been identified. One is a problem with the nonroutine supplies (NRS) digit in the HIPPS code--the last digit.
Under PPS, the system should allow that fifth digit to differ between the RAP and the final claim, regional home health intermediary Cahaba GBA ex-plains in a Jan. 29 message to agencies. That's so agencies [...]
