Home Health & Hospice Week

Home health agencies using WellSky software may need to go back and check whether a widespread, long-running glitch has affected their claims.

The problem: A software error in effect from September 2021 to October 2022 “resulted in the software using diagnosis information from the end of an episode instead of the beginning of an episode when generating, modifying, or updating a claim for a thirty (30) day period of care. This could have resulted in an incorrect diagnosis code,” says HHH Medicare Administrative Contractor CGS on its website.

The impact on affected claims can vary from underpayments to overpayments, or no reimbursement effect at all, notes HHH MAC Palmetto GBA in a post on its website.

WellSky has notified its customers of the problem, the MACs report. But wise agencies won’t take the advice the vendor offers.

The solution: “Palmetto GBA is directing HHAs who have identified claims with overpayments or underpayments due to this issue to file a reopening request (type of bill (TOB) XXQ),” the MAC instructs. “Please do not use the direction that was provided in Wellsky’s communications,” it adds.

“Reopening requests are used for a claim correction discovered and the claim is beyond the timely filing limit (one calendar year from the ‘through’ date on the claim),” CGS explains. “Reopenings are typically used to correct claims with clerical errors, including minor errors and omissions, and are conducted at the discretion of CGS.”

Take note: “Reopenings (TOB XXQ) cannot be submitted with a hardcopy (paper) UB-04. They must be submitted via electronic format or entered directly via Direct Data Entry (DDE),” the MACs advise.

See more detailed instructions in the posts at www.palmettogba.com/palmetto/jmhhh.nsf/DID/R2FP8QR3OL and www.cgsmedicare.com/hhh/pubs/news/2023/11/cope147364.html.