Home Health & Hospice Week

Billing hassles will not be so easily bypassed for certain SIA add-on scenarios.

The problem: “There are times when the [Service Intensity Add-on] payment is not being applied to the previous month,” reports one hospice in Palmetto GBA’s latest Hospice Coalition Questions and Answers set. “This occurs for us in situations where there is a sequential billing issue with another hospice, and we are past timely filing. Even when the appeal is approved, it does not always trigger the 81G for SIA reimbursement when it is due for the prior month.”

Instead, “to get paid for SIA that spans into the prior month, the biller must send the approved appeal claim back to Palmetto GBA as an adjustment AND appeal it again but add in the comments that we were not reimbursed for SIA eligible visits,” the exasperated provider relates. “Is there an update on when this may be resolved or any additional guidance?”

The solution: There’s no shortcut to fix this issue, Palmetto indicates. “Using Condition Code D9 on the adjustment, please add the remarks ‘SIA PRIOR MONTH ADJUSTMENT’ and we will bypass timeliness, if necessary,” the MAC allows.