Eli's Hospice Insider
New Claims Rejections, Returns May Be Errors — But Don't Jump To Conclusions
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Beware a new payment glitch hitting hospice claims. “Hospice claims are incorrectly rejecting with reason code C7080 indicating that one or more line item date of service overlaps with another claim,” HHH Medicare Administrative Contractor CGS reports on its website. The MAC has reported the issue to the Common Working File contractor, and there’s no action providers can take at this time. Meanwhile: MAC Palmetto GBA reports that “some claims are incorrectly returning to provider (RTP) for reason code U5181, stating there are issues with occurrence code OC 27 (missing, incorrect date, outside the dates of service [DOS], etc.),” according to the MAC’s website. “Most, if not all, of the affected claims have Occurrence Span Code (OSC) 77 (Provider Liability) and dates within the DOS.” However, hospices are reporting claims that did edit correctly for reason code U5181, Palmetto warns. Before reporting an RTP’d claim incorrectly, make sure the OC 27 date is: the correct date for the next period start date; within the DOS on the claim; and only reported on the claim for the billing period in which the certification or recertification was obtained, the MAC instructs. Remember: If “the patient is in the first certification period when they transfer to another hospice, then the receiving hospice would use the same certification date as the previous hospice until the next certification period,” Palmetto explains. Plus, when the hospice receives the recertification of terminal illness later than 2 days after the first day of a new benefit period, “they must report condition code 85 on the claim,” Palmetto says. “This code is reported with OSC 77, which reports the provider liable days associated with the untimely recertification. The OC 27 date should be the first day of covered charges (day after the thru date of OSC 77).” Get more billing information from Palmetto’s education module on the topic at www.palmgba.com/elearn/BillingOccurrence27/story_html5.html.
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