Home Health & Hospice Week

Don’t waste time on a clerical error reopening when you can submit your own provider adjustment more quickly.

HHH Medicare Administrative Contractor National Government Services “has noticed an increase in requests for CERs on claims that could have been adjusted by the provider,” the MAC says on its website. “Provider-adjusted claims will process more quickly than claims processed via the CER process and at a lower cost to the provider.”

For example: Home health and hospice providers can initiate claims adjustments to change dates of service, charge amounts, and more, notes MAC CGS on its website. (See a list of acceptable adjustment reasons and procedures online at www.cgsmedicare.com/hhh/education/materials/adjustments_cancels.html.)

Plus: “NGS does accept provider-initiated electronic adjustments to correct claims partially denied by automated LCD/NCD denials,” the MAC highlights. “If a claim or line item has been denied without medical review, that is, no ADR was sent to you and no documentation was submitted, you may correct the claim through the regular electronic claim adjustment process.” Claims eligible for these adjustments are those with line item denial reason codes 55A00, 55A01, 52NCD, 53NCD, or 54NCD.

Why? “The process is designed to allow providers to add diagnosis coding to the claim to justify services that were automatically denied based on lack of an appropriate diagnosis, according to an LCD or NCD,” NGS explains.

Initiating your own adjustments can be a good idea because “a claim adjustment begins reprocessing immediately; while a CER may take up to 60 days to complete,” NGS points out.