Home Health & Hospice Week

Pointer: Check to make sure the returned claim is actually an error.

A payment system glitch affecting Notices of Admission may soon have a solution.

The problem: “Some home health claims [are] receiving reason code 19963 in error,” HHH Medicare Administrative Contractor CGS reports on its on its Claims Payment Issues Log webpage. “This is occurring when the NOA is more than 18 months received by Medicare and have gone offline to OB9997 status/location,” CGS explains.

In other words, when the “NOA ages 18 months it automatically goes offline, it cannot be found per this business requirement and causes reason code 19963 to assign on the claim,” HHH MAC Palmetto GBA explains on its CPIL.

The solution: The claims system has been updated to prevent additional NOAs from going offline, Palmetto says. And “CMS and the MACs are working on a fix to get the claims that returned for reason code 19963 processed without provider action,” it adds.

That fix should be coming soon, says the National Association for Home Care & Hospice. NAHC has heard from the Centers for Medicare & Medicaid Services that the fix may be in place in about a week, the trade group reports.