Regulations:
Expect PPS Adjustments By The End Of The Year
Published on Wed Sep 03, 2008
Home health agencies shouldn't have too much longer to wait for the money they are owed due to prospective payment system revision errors. The Centers for Medicare & Medicaid Services indicated it would make adjustments for M0110 and other claims problems this summer. But when summer rolled around, PPS claims system problems were still cropping up and the agency pushed back that schedule (see Eli's HCW, Vol. XVII, No. 30, p. 234). The question: HHAs have been asking "when will CMS finish sweeping up from the earlier issues?" acknowledged CMS' Wil Gehne in the Sept. 17 Open Door Forum for home care providers. The answer: CMS plans to make the adjustments by the end of the year, Gehne related in the forum. More details will be in a forthcoming transmittal that is in the "final stages" of the clearance process, he pledged. Some agencies expect to receive payments from the claims errors, namely the M0110 sequencing problems, while others expect to see takebacks from errors such as inaccurate LUPA add-ons. Other issues addressed in the forum include: • OASIS warning message 257. Lots of HHAs are getting this message and they shouldn't ignore it, warned CMS' Randy Throndset in the forum that drew 355 callers. The message indicates that the HIPPS code isn't accurate. Translation: Often that message means that you are using outdated PPS Pricer software, Thrond-set explained. Make sure you or your software vendor is using the most up to date version of the pricer (see related story, p. 279). The message is a warning only, so the claim still pays, which allows agencies to ignore the warning and still receive reimbursement. But HHAs "should look into the reason ... why their grouper software is producing an inaccurate HIPPS code and correct it," Throndset urged. NRS wrinkle: One acceptable reason for the error message is the change in HIPPS codes due to nonroutine supply status, Throndset said in response to a caller. If an agency reports that it is furnishing NRS with an alphabetic fifth HIPPS code digit on the RAP and then changes it to a numeric one on the final claim because it didn't furnish NRS -- or vice versa -- the warning message will appear, he noted. That's OK. NRS edits for HHAs hit Oct. 1, Gehne added. Those edits return claims to providers if they fail to bill for NRS on the claim but use a HIPPS code indicating NRS usage (see Eli's HCW, Vol. XVII, No. 34, p. 266). Claims will pay if the HIPPS code fifth digits on the RAP and claim don't match because under PPS revisions that took effect in January, the claims system only checks that the first four [...]
