Home Health & Hospice Week

It’s time to get back your rightful reimbursement following an NOA-related billing glitch.

The problem: U537F was assigning incorrectly on some Notices of Admission, due to the Common Working File not correctly recognizing discharges (patient status other than 30 on the last HH period), HHH Medicare Administrative Contractor National Government Services noted in a May 6 message to providers.

A software update in April was supposed to fix it, but didn’t, HHH MAC Palmetto GBA reported last month.

The solution: But now the glitch was resolved as of April 25, NGS says in its message. “Effective 4/25/2022, providers can resubmit any HH NOAs (32A) that have returned to provider incorrectly and are advised to bill the KX modifier on the final HH period of care claim(s) affected by the late NOA,” NGS instructs. “The claim(s) should also include Remarks to request an exception to the late-filing penalty. These remarks can be similar to ‘Late NOA due to System Problem 34567.’”

Just beware of U537Fs that actually are returning NOAs correctly, NGS cautions. “This edit will … assign correctly on duplicate NOAs for the same admission period,” the MAC explains. “Please ensure an NOA is not already in the system pending processing or finalized prior to submitting a new NOA for a beneficiary. Home health agencies should not be submitting multiple NOAs for same admission,” NGS instructs.

And “the U537F edit will also assign correctly on NOAs if the provider CCN does not match the CCN on the prior HH episode posted at CWF,” NGS continues. “In this situation, the NOA should be billed with a condition code 47,” the MAC advises.

Bottom line: “Providers are advised to routinely verify billing before submitting a new NOA for a beneficiary admission,” NGS says.