Eli's Hospice Insider

Published on Thu Oct 20, 2016 PDF

Thought these errors were fixed? Think again.

Nearly a year into hospice payment reform, billing glitches continue to give hospices reimbursement headaches.

Issue #1: In its July Open Door Forum for home care and hospice providers, the Centers for Medicare & Medicaid Services outlined problems with Routine Home Care reimbursement and solutions that were implemented and pending. Then in August CMS notified hospices that HHH Medicare Administrative Contractors would adjust claims to correct miscounting of hospice Routine Home Care days, MAC Palmetto GBA notes on its website. Now “due to incorrect payments, MACs will stop adjustments until a solution is implemented,” Palmetto says on its website.

Issue #2: MAC National Government Services reports that “hospice claims are incorrectly being returned to the provider with reason code U5112. Providers will also see a secondary reason code of U5196 on the returned claim.” For now, hospices must hold tight while the Fiscal Intermediary Standard System contractor works the problem, NGS says.

Issue #3: But three other problems at least now have solutions. “Beginning after the July 2016 release, certain claims [with] ‘J’ HCPCs drugs were being Returned to Provider (RTP) incorrectly with reason code 32402,” Palmetto explains on its website.

“These are drugs listed on the 2016 Table of Drugs on [the] CMS website that could be administered as infused or injected. However, when billed as infused with revenue code 0294, some of the drugs caused the claim to RTP. Example HCPCS codes are: J1170, J7050, J3010, J2270, J1230 and J2250.”

Palmetto has updated the HCPC files to allow these drugs to process, it says. “Hospices can now PF9 any claims that were incorrectly returned,” it instructs.

Issue #4: Back in July, MAC CGS said it was researching hospice claims receiving reason codes 31157, 31699 and 31428. For 31157 and 31699, “if you have claims in the Return to Provider (RTP) file, you may press F9 to allow continued processing of the claim” now, CGS instructs on its website.

Issue #5: Claims receiving reason code 31428 aren’t as simple. “Claims receive this reason code when the revenue code does not have the correct corresponding HCPCS code,” CGS explains. “Oftentimes the HCPCS code is entered incorrectly. Please review the reason code narrative to ensure the correct HCPCS code is entered with the appropriate revenue code.”