OASIS Alert

Published on Fri Jan 28, 2011 PDF

You'll lose payment if you aren't using this new payer ID number by the deadline.

If Palmetto GBA is your intermediary you might not be too worried about the impending MAC transition, but you do need to make some important changes if you want to continue getting your Medicare reimbursement.

Palmetto is the current regional home health intermediary for Region C, which includes Arkansas, Florida, Georgia, Illinois, Indiana, Kentucky, Louisiana, Mississippi, New Mexico, North Carolina, Ohio, Oklahoma, South Carolina, Tennessee, and Texas. Last September, the Centers for Medicare & Medicaid Services awarded the Jurisdiction 11 (J11) Medicare Administrative Contractor business to Palmetto, which includes the Home Health and Hospice (HHH) work in the same states.

Do this: Starting Jan. 24, home health agencies and hospices must use new payer ID number 11001 on their claims, even though they are still submitting the claims to Palmetto, the MAC says in its January newsletter for providers. "This distinction is of particular importance to ... Home Health and Hospice," Palmetto says in the newsletter.

"We will work throughout the implementation to ensure that J11 providers and suppliers receive consistent, timely and clear information," Palmetto says on its new HHH section website at www.palmettogba.com/HHH.

For now, HHA and hospice chains won't have to worry about switching Medicare contractors under the new MAC system. CMS has said locations will have to submit claims to contractors based on geography when the MACs take effect.

"Chain providers will remain with their current contractors until further notice," Palmetto says in a new question and answer on its website. "Palmetto GBA expects that chain providers will be redistributed to the 'correct/geographic' MAC once all the HHH MACs are implemented."

Protests over two of the three remaining HHH MAC jurisdictions continue. Thus, there has been no transition from Cahaba GBA to Highmark Medicare Services nor from National Government Services to Noridian Administrative Services. National Heritage Insurance Corp. took over part of NGS's contract last year, but continues to subcontract with NGS for the work.

Cap exception: "Audit and enrollment activities currently handled by the parent provider's FI or MAC will stay with the FI or MAC with the exception of the hospice CAP calculation, which will be completed by HHH MAC," Palmetto adds in a separate Q&A. "The current activities handled by the Palmetto GBA RHHI will be handled by Palmetto GBA as the HHH MAC."