Home Health & Hospice Week

Reimbursement:

PPS ADJUSTMENTS HIT HANGUPS

Published on Tue Jan 13, 2009

Don't touch these suspended claims.

Your wait for your corrected prospective payment system claims may be longer than you thought.

All three regional home health intermediaries have initiated the claims adjustments for the errors the PPS claims system made starting in January 2008 (see Eli's HCW, Vol. XVIII, No. 5, p. 34). But two of the RHHIs aren't done with the adjustments yet.

Intermediary Cahaba GBA has initiated adjustment of more than 72,000 HHA claims due to the adjustments, a Cahaba rep tells Eli.

Most adjustments: The largest number of adjustments, which were still in process at press time,were for using the incorrect wage index on claims processed between Aug. 4 and Aug. 14, 2008, Cahaba says. More than 31,100 claims were corrected for that reason, which was listed as #9 in Oct. 31 CR 6250 (Transmittal No. 397) (see Eli's HCW, Vol. XVII, No. 40, p. 315).

M0110 fix: The next-biggest batch of adjustments was for the eagerly awaited early/late episode sequencing corrections combined with taking back incorrect LUPA add-ons. Cahaba processed 29,636 corrections for those items -- error #5 and error #6 in the CR ��" together, the Cahaba source reveals.

Adjustments related to LUPA add-ons that weren't wage-adjusted, error #3 in the CR, were still pending in the system at press time, Cahaba noted.

"Home health adjustments (type of bill 32I and 33I), which were initiated as part of the mass adjustments ... are incorrectly going to the RTP file with reason code 30910," Cahaba reports. Reason code 30910 applies to claims when the Fiscal Intermediary Standard System (FISS) identifies that the claim being adjusted has already been canceled, the contractor adds.

"Our suspense staff will be moving these adjustments to status/location S MHHAD," Cahaba explains. "Therefore, please do not suppress these adjustments, or take any action on these adjustments."

RHHI Palmetto GBA also hasn't completed its adjustments, providers served by the intermediary report.

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