Home Health & Hospice Week

A question-and-answer from a recent Ask The Contractor teleconference (ACT) shows why it’s important to hire a trusted billing vendor, especially under the Review Choice Demonstration.

Question: “We are using software for home health from a software vendor,” a home health agency told the Palmetto GBA ACT. “The software had a problem with submitting our claims that was later detected two weeks after all the ... claims were submitted and it went through their clearinghouse without a Unique Tracking Number (UTN) attached to the claim. All the claims we submitted were affirmed but due to a software problem it did not attach our UTN. Palmetto GBA then paid the claims with a 25 percent reduction. We called Palmetto GBA but the answer we received was that it can’t be re-submitted and/or it will be sent back to us as an Additional Documentation Request (ADR). My question, since it was a software glitch and we do have the UTN would we be able to be given this consideration to resubmit the claim?”

Answer: In this scenario, the HHA is out of luck. “While this does occasionally occur, the vendor is an extension of the provider, so the provider must respond to the ADR. Once the final claim is submitted, the Pre Claim Review process is over,” Palmetto answers.