Home Health & Hospice Week

Request a reopening to attach UTN.

Yes, Medicare wants Illinois home health agencies to still put UTNs on their claims — but only if they really belong there.

When the Centers for Medicare & Medicaid Services on March 31 called a pause for PCR in Illinois and an indefinite delay to PCR’s launch in Florida, it quickly followed up with a question-and-answer set advising Land of Lincoln providers to still include the PCR Unique Tracking Number on claims when it was already secured. “Claims submitted with a UTN will continue to be excluded from Recovery Audit Contractor (RAC) and Supplemental Medical Review Contractor postpayment reviews and most MAC prepayment and postpayment reviews,” CMS said in the Q&A set released April 4 (see Eli’s HCW, Vol. XXVI, No. 14).

In fact, Illinois agencies should even correct claims to include the UTN, CMS suggests in a Q&A revision released April 6. “If a claim was submitted without a UTN, where a valid UTN was issued, a reopening should be requested,” CMS says. “Providers should submit the reopening with the type of bill 32Q.”

But agencies need to be more careful about including UTNs on the correct claims, HHH Medicare Administrative Contractors CGS and Palmetto GBA say in new posts on their websites.

The MACs have been “receiving an increased volume of final claims from Home Health Agencies that contain UTNs previously billed for an affirmed beneficiary, but are being rebilled with a different beneficiary’s final claim,” they say. CGS and Palmetto are “also seeing instances where claims with initial and subsequent episodes of care are being billed with the same UTN,” they note.

“UTNs affirmed via PCR submission must match the beneficiary, PTAN, NPI, episode dates of care and HCPCS codes that were approved on the PCR request that is associated with the final claim being billed,” the MACs stress. “The same UTN cannot be submitted for multiple episodes of care or multiple beneficiaries.”

Watch out: “UTNs included on claims for which there is no associated PCR request may be subject to additional medical review,” the MACs warn.