Home Health & Hospice Week

Keep on top of RTP’d claims to avoid cash delays.

Don’t let a reactivated claim edit derail your payments — at least for long.

The problem: HHH Medicare Administrative Con­tractors gave home health agencies little to no notice when they turned back on Edit 31755, claims billing expert Melinda Gaboury with Provider Healthcare Solutions in her “Monday Minute with Melinda” blog. The “sudden reactivation” is making unnecessary messes for HHAs, Gaboury says.

“The edit was originally deactivated by the MACs in January 2021 to allow for five-day RAP submissions regardless if a visit had been performed yet during the associated 30-day billing period,” recalls Elizabeth Wilson with FORVIS in Springfield, Missouri. The edit was reactivated Jan. 3.

Now that that edit is back on, HHH MAC Palmetto GBA advises agencies in a Feb. 1 post that:

• Revenue code 0023 must be present;
• The claim’s “From” date, “Admit” date, and earliest 0023 line date must all be equal; and
• On a final claim, the 0023 service date must equal a visit service date or the 0023 span.

The problem is that “typically, in subsequent periods, the EMR systems have that HIPPS code line match the beginning of the billing period, which does not necessarily coincide with a visit,” Gaboury observes.

“EMRs will need to take steps to update programming to match the 0023 line item date back to the first visit on the claim,” Wilson notes. “We hope the EMRs are working on programming to accommodate this edit,” she tells AAPC.

Some good news: “Until then, this edit will not affect all claims,” Wilson explains. It affects “any claim where the first day of the billing period does not match the date of the first visit.”

More good news: “Once a claim RTPs for this reason, it is an easy fix to get your claim processing again,” Wilson says.

But “providers should routinely monitor their RTPs so they can address and fix claims quickly, to get them processing for payment,” Wilson encourages.

To resolve the issue, Palmetto instructs agencies to:

1. Ensure revenue code 0023 is present;

2. For initial periods of care (admission claims), ensure the “Admission” date, “From” date, 0023 revenue code’s “Service” date and the first visit (earliest GXXXX code) date reported on the claim all match; and

3. For subsequent periods, ensure the 0023 revenue code date matches the first visit (earliest GXXXX code) reported on the claim, regardless of whether the visit was covered or non-covered.

Bottom line: “To avoid T status claims, make sure that date on the HIPPS code line matches the first billable visit on the claim, regardless of what 30-day payment period you are in,” Gaboury advises.

Meanwhile, there is no solution yet for “claims for January 2022 that used the artificial admit date that have a different 0023 vs. first visit date,” MACs Palmetto GBA and CGS note on their Claims Processing/Payment Issues Logs. “We are researching what action to take on these claims,” they say.

Note: Palmetto’s Feb. 1 article is at www.palmettogba.com/palmetto/jmhhh.nsf/DID/8B4QZU7070.