Home Health & Hospice Week

Beware an ongoing payment system glitch that could be hanging up your hospice claims — but don’t blame all your returned claims on the problem.

Problem: “Some claims are incorrectly returning to provider (RTP) for reason code U5181, stating there are issues with occurrence code OC 27 (missing, incorrect date, outside the dates of service {DOS}, etc.),” reports HHH Medicare Administrative Contractor Palmetto GBA on its website.

“Most, if not all, of the affected claims have Occurrence Span Code (OSC) 77 (Provider Liability) and dates within the DOS.”

However, hospices are reporting claims that did edit correctly for reason code U5181, Palmetto warns. Before reporting an RTP’d claim incorrectly, make sure the OC 27 date is: the correct date for the next period start date; within the DOS on the claim; and only reported on the claim for the billing period in which the certification or recertification was obtained, the MAC instructs.

Remember: If “the patient is in the first certification period when they transfer to another hospice, then the receiving hospice would use the same certification date as the previous hospice until the next certification period,” Palmetto explains.

Plus, when the hospice receives the recertification of terminal illness later than two days after the first day of a new benefit period, “they must report condition code 85 on the claim,” Palmetto says. “This code is reported with OSC 77, which reports the provider liable days associated with the untimely recertification. The OC 27 date should be the first day of covered charges (day after the thru date of OSC 77).”

Get more billing information from Palmetto’s education module on the topic online at www.palmgba.com/elearn/BillingOccurrence27/story_html5.html.