Home Health & Hospice Week

A claims system glitch is giving home health agencies more work to obtain their rightful reimbursement.

The problem: “In 2021, certain [Core-Based Statistical Area] codes change from urban to rural designation. However, these select counties Federal Information Processing Standards (FIPS) codes were not added to the home health add-on table, causing the claims to Return to Provider (RTP) with reason code 37257,” HHH Medicare Administrative Contractor Palmetto PBA recounts on its claims payment issues webpage.

The solution: A fix is “in development for implemen­tation” but has no definite date. Meanwhile, “as a temporary workaround until the Pricer module is corrected, HHAs affected by this issue may submit 2021 claims with the 2020 Core-Based Statistical Area (CBSA) codes to receive reimbursement,” Palmetto instructs.

The catch: “This will bypass the edit and likely cause an underpayment,” the MAC admits. “Once the fix is implemented, HHAs will need to adjust their claims and correct the to receive correct reimbursement.”