Home Health & Hospice Week

A new Medicare claims system update means new payment problems to work through. Unbeknownst to many providers, CMS now requires all provider types to include Type of Admission codes on all claims, including requests for anticipated payment (RAPs), final claims, and hospice claims. The requirement was buried in CMS's 303-page Nov. 10, 2010 Transmittal 2090 (CR 7202), according to regional home health intermediary Cahaba GBA.

The codes are not required on hospice notices of election (NOEs), Cahaba adds.

The valid Type of Admission codes are: 1 -- Emergency; 2 -- Urgent; 3 -- Elective; 4 -- Newborn; 5 -- Trauma; and 9 -- Information not Available, Cahaba says. "When submitting billing transactions via Direct Data Entry (DDE), enter the Type of Admission code in the TYPE field on Claim Page 01 of the Fiscal Intermediary Standard System (FISS)," the intermediary instructs.

Tip: The requirement applies to all claims received April 4 and later, regardless of date of service. That will include claims resubmitted from the Return to Provider (RTP) file, Cahaba points out.

Meanwhile, if you furnish outpatient therapy, the system is calculating coinsurance amounts incorrectly for claims containing any of 44 therapy codes, HHH MAC Palmetto GBA says on its website. "The issue will be corrected with a system fix," Palmetto says. "However, a production implementation date has not yet been determined." Once a fix goes in, previously submitted claims will be adjusted.

The April claims system update has also resolved some problems. Formerly, CMS told contractors to hold hospice claims editing with reason code 31503 until a correction was installed with the April 4 update, Cahaba notes on its website. Thesystem should now automatically process held claims, and hospices with claims returned in error with that reason code can resubmit them.