Home Health & Hospice Week
Watch Out For These New Hospice RTP Codes
Are you reporting the new required data on your hospice claims? Now that hospices must report additional claims detail for visits with the appropriate revenue codes and HCPCS codes, there are also new reason codes for related returned to provider (RTP'd) claims. New reason code 31428 indicates that "this claim contains a hospice discipline revenue code (42x, 43x, 44, 55x, 56x, or 57x) that does not have the corresponding HCPCS code (G0151, G0152, G0153, G0154, G0155, or G0156)," regional home health intermediary Cahaba GBA explains. New reason code 31429 indicates that "this claim contains a hospice discipline revenue code 569, but does not have the corresponding HCPCS code G0155," the intermediary says on its Web site. The codes will appear on claims dated Jan. 1 or later that don't contain the required information, Cahaba adds. More details about the claims requirements are at www.cms.hhs.gov/MLNMattersArticles/downloads/MM6440.pdf. • DME suppliers have more to answer for, thanks to a new report from a federal watchdog agency. More than half of DME claims from 2006 that the HHS Office of Inspector General reviewed were missing required documentation. Of 100 claims suppliers submitted with the KX modifier, 54 lacked supporting documentation such as proof of delivery, physician's orders, and physician statements, the OIG concludes in the report at www.oig.hhs.gov/oas/reports/region4/40804020.pdf. The KX modifier is supposed to indicate that the supplier has the required documentation on file, the report notes. Medicare improperly paid $4,600 for the items missing documentation, the OIG calculates. Judging from the sample, DME regional carrier Palmetto GBA paid $127 million in unallowable payments based on the problem, the OIG estimates. Among other actions, the DMERC that took over for Palmetto, CIGNA, will report the suppliers who violated the supplier standards by failing to maintain proof of delivery to CMS and the National Supplier Clearinghouse, CIGNA says in comments on the report. • Another indicator that the Department of Health and Human Services is getting serious about cracking down on Medicare fraud: a Jan. 28 "National Summit on Health Care Fraud" involving HHS Secretary Kathleen Sebelius, U.S. Attorney General Eric Holder, elected officials, law enforcement personnel, and the public. The summit, which is an initiative by the Health Care Fraud Prevention & Enforcement Action Team (HEAT), brings together "leaders from the public and private sectors to identify and discuss innovative ways to eliminate fraud, waste and abuse in the U.S. health care system," HHS says. "This unprecedented all-day session is a first of its kind between law enforcement and the private and public sectors," HHS adds in a release. "The summit will focus on sharing best practices and experience to develop new ways to eliminate health care fraud." • CMS has posted the 2010 home health prospective payment system PC Pricer on its Web site at www.cms.hhs.gov/PCPricer/05_HH.asp.And CMS also has released a new version of PC-Ace Pro32 for Medicare Part A, RHHI Cahaba GBA notes. You can download it at www.cahabagba.com/rhhi/edi/software.htm, but you'll need to call Cahaba to get the password for the file. • If you aren't yet registered in Medicare's new provider statistical and reimbursement system, you're getting one last freebie on PS&R reports. "The September 30, 2009 cost report is due March 1, 2010, or 30 days from the receipt of the Summary PS&R reports, whichever is later," RHHI Cahaba GBA says in a message to providers. "CMS has advised us to send the PS&R reports to providers with a September 30, 2009 cost reporting period due to issues providers are encountering with obtaining these reports through the CMS online PS&R system." Previously, CMS and the intermediaries said providers would be responsible for obtaining the reports on their own through the new system, which requires an IACS (Individuals Authorized Access to CMS Computer Systems) password. "PS&R reports will not be sent again," Cahaba stresses to providers. "It is your responsibility to obtain future reports you require directly from the PS&R system." • Do you have trouble finding what you need in CMS's complex Web site? If so, a new tool may help you. CMS's Medicare Learning Network has issued a two-page quick reference chart that includes a list of CMS Web pages that all Medicare providers use frequently. The chart is at www.cms.hhs.gov/MLNProducts/downloads/quick_reference_all_medicare_providers.pdf. For a free pdf copy, e-mail editor Rebecca Johnson at rebeccaj@eliresearch.com with "Quick Reference Chart" in the subject line. • If you're looking for a brief tool to explain the home health prospective system to laymen like patients or referral sources, you may wantto tap a newly updated resource. CMS's Medicare Learning Network has issued its 2010 HH PPS Fact Sheet online at www.cms.hhs.gov/MLNproducts/downloads/HomeHlthProsPaymt.pdf. The four-page fact sheet "provides information about coverage of home health services and elements of the Home Health Prospective Payment System," CMS notes. • The number of health care fraud investigations continues to grow steadily, the U.S. Department of Justice says. For example: Perkins could face up to five years in prison for his crime, the prosecutors say. The OIG, •
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