Home Health & Hospice Week
Beware Claims Processing Glitch That Is Recoding Later Periods As Early Under PDGM
Beware of PDGM overpayments that you’ll have to repay later — or underpayments you’ll miss out on. The problem: “Home health claims are being incorrectly recoded by the processing system to early periods when they should be coded and processed as late periods,” HHH Medicare Administrative Contractor Palmetto GBA says on its website. “This is occurring when there is a separation between the end of one period to the start of the next period of 60 days or less. This may result in a change from a full period payment to a low utilization payment adjustment (LUPA) payment, which causes an underpayment.” The solution: “The issue is in research,” Palmetto says. Until it’s corrected, home health agencies can report affected claims to the MAC and it can manually recode them. It’s up to HHAs to bring such claims to Palmetto’s attention, the MAC says.
Home Health & Hospice Week
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