Home Health & Hospice Week

Add one more headache to your Medicare claims pain list: keeping track of incorrect payments due to a recent pricer software change.

The home health prospective payment system pricer was implemented in May and contained the 3 percent add-on for rural patients for home health agencies, notes regional home health intermediary Cahaba GBA in a message to providers.

The problem: "The Pricer is calculating the non-routine supply reimbursement for all HH PPS payments using the 3 percent rural add-on rate instead of just those submitted with a rural CBSA code," Cahaba explains. "This is causing some HH PPS claims to be overpaid."

The solution: HHAs are waiting on a fix for the problem. "When a resolution is received, providers will be notified through another e-mail message," Cahaba promises.

Agencies should keep track of the erroneously paid claims, advises reimbursement consultant M. Aaron Little with BKD in Springfield, Mo. "Once the error is fixed, the claims will need to either be reprocessed manually or will be automatically reprocessed," Little tells Eli. "We don't know yet which of these two will be required."