Home Health & Hospice Week

Watch out for a newly reported claims glitch that could be costing you your rightful reimbursement — at least for six months.

The problem: “When a claim is initially processed with a [HIPPS] code indicating a community admission but Common Working File (CWF) finds an applicable inpatient claim, CWF rejects the claim with edit 727D. This edit identifies the claim for regrouping and repricing under an institutional payment group,” HHH Medicare Administrative Contractor Palmetto GBA explains in its claims issues log. “HHH MACs have reported that this process is not working correctly if the post-acute stay was received in an inpatient rehabilitation unit or a psychiatric unit of a Critical Access Hospital (CAH).”

The solution: “A system correction is targeted for the April 2022 release,” Palmetto reports, which is more than six months away. Since “claims currently cycling with CWF edit 727D cannot be manually recoded in the interim … home health and hospice MACs shall hold any claims cycling with CWF edit 727D for this issue until the new CR can be implemented. MACs shall append condition code 15 to these claims before they are released.”

HHAs do have a solution if they don’t want to wait more than six months for the claims system to fix it. To avoid the glitch, they can identify “inpatient discharges from a CAH that occurred during the 14-day window of the HH admission and [submit] a HIPPS with the first position of the code identifying institutional early (2) or institutional late (4) on the Request for Anticipated Payment (RAP),” Palmetto instructs. “HHAs should also report occurrence code 62 and the CAH discharge date (‘through’ date),” the MAC adds.

Don’t forget: If they use the work-around, “HHAs still must ensure matching HIPPS are submitted on the RAP and corresponding claim for the period,” Palmetto says.