Home Health & Hospice Week

LUPA-related glitch should be fixed shortly.

CMS and its contractors are knocking out Patient- Driven Groupings Model billing problems, but more remain.

Three PDGM and no-pay RAP-related billing problems were corrected this month, with another fix on the way shortly, reported a Centers for Medicare & Medicaid Services staffer in the agency’s April 13 Home Health Open Door Forum. HHH Medicare Administrative Contractor CGS describes the glitch to be fixed like this: “Some LUPA claims are being incorrectly rejected with claim reason code 39929 and line level reason code 37363 indicating the request for anticipated payment (RAP) was submitted untimely.”

MACs were supposed to receive instructions for a workaround and to correct claims payments in the “next few days,” the CMS source told forum attendees.

A tougher nut to crack is the problem with the Medicare claims system sometimes failing to replace dummy HIPPS codes with the real, system-calculated ones when paying final claims under PDGM, the CMS speaker admitted. Contractors “are still working out the mechanism of that problem,” he told a caller. “It’s been very tough to diagnose.”