Home Health & Hospice Week

Watch out for Type of Bill switcheroo.

Keep an eye out for the latest reported billing error holding up your reimbursement.

Problem No. 1: “Some recently received hospice and home health (HH) claims [are] changing the submitted Type of Bill (TOB) to XX0 (8X0 for hospice or 320 for HH), a non-pay TOB, and assigning Reason Codes that start with ‘5Z’ to the claims,” HHH Medicare Administrative Contractor Palmetto GBA reports on its Claims Payment Issues Log webpage.

Solution No. 1: While Palmetto hasn’t fixed the problem yet, “we have turned off the identified erroring “5Z” edits and newly submitted claims should not receive them,” the MAC tells providers. “We are following the affected claims and determining a solution to correct them,” it adds.

In the meantime, “do not submit duplicate claims, as they will be returned,” Palmetto instructs.

Aging NOAs Cause Problems

The MAC has resolved another billing issue from last year, however.

Problem No. 2: “Some home health claims [are] receiving reason code 19963 in error,” HHH Medicare Administrative Contractor CGS reported on its on CPIL webpage. “This is occurring when the NOA is more than 18 months received by Medicare and have gone offline to OB9997 status/location,” CGS explained.

Solution No. 2: Palmetto has restored all the affected NOAs and processed any associated claims returned with reason code 19963 in error, it reports. The other MACs hadn’t updated their CPILs on the matter as of press time.

Problem No. 3: Meanwhile, time will tell if a Feb. 12 system fix will work. Beginning on Jan. 2, claims have returned to provider (RTP’d) in error because the values loaded in the iQIES system did not populate in FISS, CGS says on its CPIL. Affected claims suspend to status/location (S/LOC) SM1033.

Solution No. 3: A system update is supposed to address the issue.

Note: The Palmetto CPIL is at www.palmettogba.com/ palmetto/jmhhh.nsf/T/Claims~Claims Payment Issues Log and the CGS CPIL is at www.cgsmedicare.com/ hhh/claims/fiss_claims_processing_issues.html.