Home Health & Hospice Week

A ZPIC edit has led to erroneous denials, but HHH MAC Palmetto GBA will fix them with mass adjustments, the contractor says.

“Providers have had denials for full claims with Reason Code 5Z7D1 or line denials with Reason Code 5Z7D2, narrative ‘Home Health Skilled Nurse Not Reasonable and Necessary,’” Palmetto explains. “The ‘Z7’ of the Reason Code refers to ZPIC Zone 7, Safeguard Services, the ZPIC for Home Health and Hospice in Florida.”

What to do: Sit tight for the mass adjustments Palmetto will perform, the MAC says.

What not to do: “Claims incorrectly denying for this reason code should NOT be referred to Safeguard Services,” Palmetto instructs. Also, claims with those denials may not be adjusted if the denial was actually correct, the MAC adds. For a “small number of claims from some Home Health Agencies in the state of Florida, this edit may be correct and will not be removed in a mass adjustment to correct erroneous denials,” Palmetto says.