Home Health & Hospice Week

If some of your claims are being adjusted but have maintained the same payment rate, they may be among the approximately 9,000 that HHH Medicare Administrative Contractor Palmetto GBA is correcting for erroneous A/B shifts.

The problem: The claims system “was designed that once the final payment for an episode is calculated, the Medicare claims processing systems will determine whether the claim should be paid from the Medicare Part A or Part B trust fund,” Palmetto explains on its website. “The shift of payment for home health claims was not working as designed.”

The solution: “Palmetto GBA is adjusting the approximately 9,000 claims that did not have the shift occur, but should have,” the MAC says. “The purpose of the adjustments is to shift the payment fund value codes from A to B (or vice versa). The Type of Bill (TOB) for the adjustments is 32G and the remarks will state ‘A/B SHIFT.’ These adjustments will take at least 90 days to complete” and “no provider action is required,” Palmetto adds.

The MAC will make “this A-B shift determination … only on claims, not on request for anticipated payments (RAPs),” it adds. “Value codes for A and B visits (value codes 62 and 63) and dollar amounts (64 and 65) may be visible to HHAs on electronic claim remittance records, but providers do not submit these value codes.”