Home Health & Hospice Week

Industry Note:

Corrected Claims Glitch Could Cause Takebacks

Your claims that must be recoded to or from a high-therapy HIPPS code should now be paying correctly.

The problem: Starting in January, “when the provider-submitted HIPPS codes began with 5, or when 20 or more therapy visits were provided and the provider-submitted code was recoded to a HIPPS code beginning with 5,” payment was incorrect, the Centers for Medicare & Medicaid Services notes in MLN Matters Article No. 9608. “As a result of this error, claims that were recoded to a different payment group were assigned incorrect HIPPS codes.”

The solution: The April 25 update to the HH Pricer software should fix the problem, CMS notes in the article. Then HHH Medicare Administrative Contractors will go back and adjust affected claims within a month, the agency says.

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