Follow these expert tips for avoiding some common billing snarls. If you don't keep on top of your returned claims, you could be saying "no thanks" to part of your Medicare reimbursement.
Regional home health intermediary Palmetto GBA recently released its top reason codes given when claims are returned to provider (RTP'd). Two list toppers address duplicate submissions.
Code 31857 says, "This RAP is a duplicate of a paid RAP or paid, suspended or denied home health claim for the same provider number, HIC number and statement 'FROM' date, but without a cancel date," Palmetto explains.
Code U5600 indicates, "The incoming claim admit, FROM, and THRU dates equal a claim on history. CWF has identified this record as a duplicate claim," Palmetto points out.
Home health agencies receiving RTP'd claims with these reason codes should explore a number of possibilities, advises Lynn Olson with billing service Astrid Medical Services in Corpus Christi, TX. "Billing is a logical process with many checks and balances," Olson tells Eli. "Understanding the system is the key." Check for these common scenarios:
Attention to detail is a must for billing accuracy, Olson stresses.
Although it seems counterintuitive, in autocancel situations where you want to correct the RAP you must 1) submit a second, incorrect RAP to replace the first incorrect RAP that was autocancelled; 2) cancel the second incorrect RAP; and 3) submit a new, corrected RAP.
Editor's Note: To see Palmetto's top reason codes and more advice for resolving related edits, go to www.pgba.com.