Home Health & Hospice Week

If billing system problems have been slowing your cash flow, you’re not alone.

Glitch #1: Some home health claims have incorrectly denied with Reason Code (RC) 5Z4SO,” reports HHH Medicare Administrative Contractor Palmetto GBA.

Fix #1: “The edit that caused the incorrect denials was fixed on 8/29/17. Claims submitted after 8/29/17 should not incorrectly deny for this RC. Palmetto GBA is adjusting the claims that incorrectly denied for this edit,” the MAC says.

Glitch #2: While this is not actually a glitch, but a claims system change, it’s been catching many home health agencies and hospices unawares. “Effective August 7, 2017, the Fiscal Intermediary Standard System (FISS) no longer accepts information entered in the POA indicator field for home health and hospice claims,” says MAC CGS, which has been receiving calls about the affected claims returned with reason code 34961. “The POA Indicator is a one position field that follows the DIAG CODES field on FISS Claim Page 03,” CGS adds.

Fix #2: “If your claim is in the RTP file (TB9997) with reason code 34961, remove any character that appears in that field,” CGS instructs. “We encourage home health and hospice providers to work with their vendor to ensure information is not submitted in the POA indicator field.”