Eli's Hospice Insider

Published on Mon Aug 18, 2014 PDF

Warning: Don’t forget to resubmit affected claims for your rightful reimbursement.

You should be getting relief from Medicare’s inability to support its requirement to bill infusion pumps and other DME, at least if CGS or Palmetto GBA is your MAC.

The problem: Starting April 1, the Centers for Medicare & Medicaid Services has required hospices to report a slew of new data, including durable medical equipment like infusion pumps, on their claims. But the claims system has returned “certain claims” in error, admitted CMS’s Wil Gehne in the agency’s July 9 Open Door Forum for home care and hospice providers. Those are claims with infusion pumps, hospices relate.

The solution: CMS developed instructions to Medicare Administrative Contractors to override reason codes W7061 and W7072, which were returning those claims, Gehne revealed in the forum.

When the instructions take effect, the override will take place automatically, Gehne explained in the question-and-answer portion of the call. But agencies will have to resubmit claims returned in error previously.

HHH Medicare Administrative CGS is releasing such held-up claims, which are located in status location S M7061 and S M7072, it says.

“Palmetto GBA implemented the override function on July 16, 2014,” the MAC reports on its website. 

Don’t forget: The fix requires MACs to override reason codes W7061 and W7072. “Hospices can now resubmit (PF9) their returned claims for processing,” Palmetto directs.

National Government Services had not made an announcement on the topic at press time.

If you don’t want to wait for the override process to take effect to claim your rightful reimbursement, you do have another option. Hospices may submit claims stripped of the infusion pump data, then submit an adjustment for the claim later, Gehne confirmed in the forum. Each hospice may decide whether to use that option based on what’s best for their business process, he said.