Home Health & Hospice Week

If you’ve received less pay than you were supposed to due to the Medicare claims system failing to replace your dummy HIPPS code with the real one under PDGM, that problem may now be fixed. But you’ll have to take action to retrieve your rightful reimbursement.

Do this: The Centers for Medicare & Medicaid Services “and the software maintainers are working on an issue with the GROUPER software,” HHH Medicare Administrative Contractor CGS reports on its website. “At this time, if you feel that your claim processed with the incorrect HIPPS code, submit an adjustment, and add ‘REMARKS’ indicating that the claim originally paid with the incorrect HIPPS Code. The adjustment will allow the claim to go through GROUPER and apply the correct HIPPS code.”

You need to follow up too, however. “If the adjustment does not process with the correct HIPPS code, please contact the Provider Contact Center,” CGS instructs.