Home Health & Hospice Week

You have HIPAA to thank for more administrative inflexibility. The Health Insurance Portability and Accountability Act requires the Centers for Medicare & Medicaid Services to scrap the 90-day grace period that used to be in place for changes to both HCPCS and ICD-9 diagnosis codes, according to two new transmittals (Nos. 89 and 95). The grace period aimed to allow providers "to ascertain the new codes and learn about the discontinued codes," CMS says. HIPAA's "transaction and code set rule requires usage of the medical code set that is valid at the time that the service is provided," the agency says. "Therefore, CMS is eliminating the 90-day grace period for billing discontinued ICD-9-CM diagnosis codes" effective Oct. 1, 2004 and HCPCS codes effective Jan. 1, 2005, CMS tells providers in the Feb. 6 transmittals. You'd better go back and check your rejected claims from January again if Palmetto GBA is your regional home health intermediary. Claims received by Palmetto between Jan. 16 and Jan. 20 may have been incorrectly rejected as duplicates, Palmetto says on its Web site. The claims, which would have appeared on remittance advices (RAs) dated Jan. 23, 24 and 25, can be identified with reason code (RC) 18. "If your claim did not process for payment due to an incorrect rejection as a duplicate, please resubmit the claim for payment," Palmetto instructs. Starting this July, there'll be a new name for first-level Medicare appeals - redeterminations, CMS decrees in Feb. 6 Transmittal No. 97. And that's not the only change. Contractors must complete all redeterminations within 60 "If your claim did not process for payment due to an incorrect rejection as a duplicate, please resubmit the claim for payment," Palmetto instructs. Starting this July, there'll be a new name for first-level Medicare appeals - redeterminations, CMS decrees in Feb. 6 Transmittal No. 97. And that's not the only change. Contractors must complete all redeterminations within 60 days, and use a new letter to inform providers of their decisions. More appeals system changes required in recent years' Medicare laws will be forthcoming, CMS promises. Tired of getting conflicting advice from different intermediaries and carriers?
Instead of relying on various contractors to write up provider education articles on new CMS instructions in the very short window of time after their issuances, CMS will now provide both the instruction and the education article at the same time, the agency says in Feb. 5 Transmittal No. 54. "CMS has decided to prepare consistent materials for contractor outreach for Medicare providers in a centralized fashion," available on CMS' Medlearn Web site (www.cms.hhs.gov/medlearn/matters). CMS aims to eliminate disparities due to differing interpretations or just confusing or inadequate educational language, it says. Twenty [...]