Home Health & Hospice Week
Learn The Ropes To ID Claims Suspensions
Are suspended claims confusing you and holding up your reimbursement? You can get a clue about what to do with your claims from a recent HHH Medicare Administrative Contractor educational article. "The Home Health and Hospice Provider Contact Center (PCC) has received an increase in calls from providers with questions about claims that are in a suspended status/location," notes MAC CGS in the article. "As billing transactions process in FISS, they move through various stages of the system. Each stage is identified by a status/location that can provide information about what's happening to the claim," the MAC explains. "The status code 'S' means the claim is suspended for processing," CGS elaborates. "Locations further define what is happening with the billing transaction. Locations are 5-character positions." For example: You'll see S B6000 for one day when a claim is getting ready to get an Additional Development Request. Subsequently, you'll see code S B6001 for the claim when it's officially been ADR'd. Another good code to know is S M50MR, which indicates the MAC has received your ADR information. "Please note that the review process may take up to 30 days to complete or 60 days for demand denials (condition code 20)," CGS says. Providers should pull the trigger on calling about suspended claims only "if a claim has been in the same 'S MXXX' status/location for longer than 30 days, or 60 days for Medicare Secondary Payer claims," CGS instructs. You can determine how long the claim has been in a status by checking the "TRAN DT" field in FISS. Instructions on how to do so, as well as more of the most common status and location code combinations, are at www.cgsmedicare.com/hhh/pubs/news/2018/0418/cope7318.html.
Home Health & Hospice Week
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Learn The Ropes To ID Claims Suspensions
Are suspended claims confusing you and holding up your reimbursement? You can get a clue [...]
