Home Health & Hospice Week
Check Claims For Patient Name/HIC Number CWF Mismatch
If you’re seeing more returned claims due to a patient name or HIC number mismatch with the Common Working File, you’re not alone.
Background: Starting Oct. 1, Medicare Administrative Contractors have been returning claims on which the beneficiary’s name or HIC number doesn’t match the CWF information. The transmittal from April detailing the change is online at www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R2449CP.pdf.
"We have seen an increase in reason code N5052 (name/number does not match what is on file)," says HHH MAC NHIC in a message to providers.
"In October 2012, reason code N5052 … was a top billing error for home health and hospice providers billing to CGS," that MAC adds in a post on its website.
Do this: "It is very important for providers to be aware that when checking the beneficiary’s eligibility, the name may include apostrophes, commas, hyphens, JRs, and other similar suffixes," NHIC says. "If the beneficiary’s name contains apostrophes, commas, hyphens, JRs, and other similar suffixes, then the name on incoming claims must have this information also."
"Home health and hospice agencies … should be verifying the beneficiary’s name and HICN by obtaining a copy of the beneficiary’s red, white and blue Medicare card," CGS instructs. "In addition, providers should be using Page 01 of ELGH or ELGA to ensure they are submitting the beneficiary’s correct name and HICN on their billing transactions prior to submitting them to Medicare."
Home Health & Hospice Week
- Regulations:
Don't Count An Extra Therapy Visit By Mistake Under New Rules
Final rule language leaves many agencies with wrong impression, expert warns. If you thought you [...] - Hospice:
Use Correct Patient Status Codes, CMS Urges Hospices
Also: You're still the one responsible for your quality data submission, not your vendor. Even [...] - Compliance:
OIG OKs Free Program Offering Non-Skilled Services
3 factors keep proposed arrangement in the clear. The OIG has put its stamp of [...] - Kickbacks:
Beware Pitfalls In Furnishing Bridge Services
Follow these 5 steps to compliance. If you want to protect your free services program [...] - Industry Note:
DME Suppliers Top GAO's List Of Fraudsters
But HHAs aren't doing too badly at all. The percentage of home health agencies that [...] - Industry Note:
Study Points To Enrollment Policies As Factor In Hospice Underuse
Payment limitations may be more of a factor in hospice underuse than many providers think. [...] - Industry Note:
Check Claims For Patient Name/HIC Number CWF Mismatch
If you’re seeing more returned claims due to a patient name or HIC number mismatch [...] - Industry Note:
Get SNF Hospice Patient And Enrollment Answers From Palmetto
A recent question-and-answer session with Palmetto GBA revealed helpful advice from a panel of Medicare [...] - Industry Note:
Register Now For Therapy Functional Reporting Call
Want to get up-to-speed on therapy functional reporting? CMS is holding a National Provider Call [...] - Industry Note:
SEC Concludes Financial Compliance Investigation
Recently completed Securities and Exchange Commission investigations handed down a clean bill of financial-compliance health [...] - Industry Note:
Prepare For Mileage Rate Increase
Get ready to pay more for mileage, as the IRS is increasing business travel mileage [...] - Industry Note:
HHA Closes After Losing Medicare, Medicaid Payment
ABC Homecare LLC closed after losing its Medicare and Medicaid reimbursement, following an unfavorable survey [...] - Industry Note:
HHA Owner Sentenced For Home Care Fraud In St. Louis
HHA owner Rose Ray-Vasser is facing 30 months in prison and $398,000 in restitution for [...]
