Medicare Compliance & Reimbursement

But how long will it take to catch up? After nearly three weeks under the revised prospective payment system, home health agencies (HHAs) are starting to see their Medicare claims pay. Medicare installed the PPS software fixes Jan. 17, a Centers for Medicare & Medicaid Services (CMS) official says. The regional home health intermediaries (RHHIs) are releasing the held claims and those are processing toward payment, the source says. Dates for those activities will vary by intermediary, the CMS staffer adds. RHHI Cahaba GBA released its held claims Jan. 17, it says in a message to providers. Intermediary Palmetto GBA did so on Jan. 18. National Government Services and Associated Hospital Service haven't said if or when they've released their held claims, although Bob Wardwell with the Visiting Nurse Associations of America reports that they have. The previously reported problems with CBSA codes (error code 32038) and HIPPS codes straddling 2007 and 2008 appear to be "largely cleared up," cheers Baton Rouge, LA-based software company Lewis Computer Services on its Web site. "That part of the software update seems to have been successful." The problem with treatment authorization codes (30720) is now editing correctly, Cahaba and Palmetto say. That means claims held up for that reason are probably due to software or other errors on the HHAs' end. Requests for anticipated payments (RAPs) and claims are starting to process, agrees billing consultant Rose Kimball with Med-Care Administrative Services in Dallas. "The money must be starting to flow," notes Wardwell, a former top CMS official who oversaw PPS' original implementation in 2000. "The complaint volume is diminished." But it is taking time to resubmit returned claims and navigate some of the Direct Data Entry (DDE) format changes, Kimball laments. Even when claims do pay, providers will have a tough time reconciling them with what should have been paid, Kimball expects. A claim for a patient who had a fall mid-episode and begins therapy will see drastically different reimbursement than what was indicated on the RAP, Kimball notes. But under PPS revision rules, you still submit a final claim with the same HIPPS code and the system auto-adjusts it for the increased therapy. That bumps the episode into a whole new grouping step, HIPPS code and payment level that will be "drastically different," she says. While the major problems that were holding nearly all 2008 RAPs for three weeks are now clearing up, there are still more payment system issues ahead. The system is failing to auto-adjust certain episodes when needed, Cahaba warns in a Jan. 18 email to providers. The error occurs (1) when the first digit of the HIPPS code doesn't reflect the actual episode number or (2) when the [...]