Home Health & Hospice Week
Beware This LUPA Billing Glitch
Hospice pay reform change causes HHA underpayments.
A newly reported billing error related to nursing G codes could be short-changing your shortest-stay claims.
The problem: “Medicare systems used HCPCS code G0154 in the criteria for identifying the earliest visit date when calculating low utilization payment adjustments (LUPA) add-on amounts. G0154 was retired ... and replaced with HCPCS codes G0299 or G0300, effective 1/1/2016. Currently, G0299 or G0300 are not used in the LUPA calculation,” says HHH Medicare Administrative Contractor Palmetto GBA on its website. “This will result in some claims not receiving LUPA add-on amounts or receiving a payment based on the wrong service discipline.”
Reminder: G0299 (direct skilled nursing services of a registered nurse [RN] in the home health or hospice setting) and G0300 (... of a licensed practical nurse [LPN] ...) were necessary to facilitate Service Intensity Add-on (SIA) payments under hospice reform that took place Jan. 1.
The solution: The fix is scheduled for July, Palmetto informs providers. And agencies are off the hook to get back their rightful payments. CR 9474 on the matter “instructs contractors to adjust home health claims to correct payments.”
Home Health & Hospice Week
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