Home Health & Hospice Week

Notice of Admission claims using modifier KX when they shouldn’t are in one MAC’s crosshairs.

The problem: Claims glitches early this year led to delays in new Home Health NOAs processing. HHAs could then use a KX modifier to request an exception to the five-day filing deadline. However, “we recently identified a high volume of claims submitted with modifier KX in error,” reports HHH Medicare Administrative Contractor CGS. “For example: The Claims Processing Issues Log indicates reason code 32114 was resolved on January 14, 2022, but we continue to receive TOB 329 claims with modifier KX,” the MAC says.

The solution: “Continue to monitor the Claims Processing Issues Log and only report modifier KX when appropriate,” CGS tells providers on its website.

Meanwhile, HHH MAC Palmetto GBA has reopened an NOA problem it thought it had resolved. Reason Code “U537F is continuing to assign incorrectly on some NOAs since the April 2022 System Release implementation,” Palmetto says on its CPIL.

RC U537F will return to provider an NOA when it overlaps another home health stay or is a duplicate, Palmetto notes. If a provider determines that RC U537F did not edit for a valid reason, “we will provide additional updates when available,” Palmetto says. “There is no workaround at this time.”

However, if the NOA was initially held up by the glitch but then processed and was late, request an exception with the KX modifier, Palmetto instructs.