Home Health & Hospice Week
HHA Claims Face Returns Due To New Nursing G-Codes
Plus: CBSA issues kick out claims.
A New Year often means a new batch of claims headaches thanks to system updates and payment changes, and 2016 is no exception.
Problem #1: Home health claims are Returning to Provider with the newly required nursing G-codes G0299 and G0300, reports HHH Medicare Administrative Contractor Palmetto GBA.
Tip: “For Home Health episodes that span January 1, 2016, home health providers are required to report HCPCS code G0154 for 2015 visits,” Palmetto reminds providers. But that doesn’t appear to be the only problem, because the MAC says it is further researching the issue.
A glitch related to this new requirement is not exactly a surprise, notes Lynn Olson with billing company Astrid Medical Services in Corpus Christi, Texas.
Even if your agency hasn’t seen claims hit with these RTPs, you need to stay vigilant, suggests billing expert M. Aaron Little with BKD in Springfield, Mo. “The volume of claims ending during January that are actually in process is low compared to what it will be in the coming weeks,” Little tells Eli. Problematic returns may surface for you later. Stay tuned to Palmetto for more info.
Problem #2: Claims have been RTPing with reason code 7CBS1 incorrectly indicating that an invalid CBSA code was submitted, reports HHH MAC CGS on its website.
Tip: The appropriate files have been updated, and providers should F9 the claim from the RTP file, CGS instructs. But “if the claim continues to receive the 7CBS1 error, and you have verified that the CBSA code is valid,” contact the MAC.
Problem #3: Another CBSA-related claims return is on you, however. If your claim is RTPd with reason code 7ECBS, it’s because you are using an outdated 5xxxx CBSA code for a blended wage index area. “The blended wage index does not apply to claims with Through dates on or after January 1, 2016,” CGS informs providers on its website.
Tip: “Providers should ensure that the correct CBSA code is submitted,” and that won’t be a 5xxxx code for claims ending Jan. 1 or later, CGS says.
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