Home Health & Hospice Week

Home health agencies' efforts to make sure they receive fair payment for supplies in the future could be preventing them from receiving payment for whole patient episodes now.

The Medicare claims processing system has suspended many claims that include revenue lines for supplies - both codes 623 and 270, the Centers for Medicare & Medicaid Services says in a message to providers. The system is failing to add the supply charges into the total charge for the claim, and thus it's holding up those claims for not having matching amounts, CMS explains.

HHAs served by regional home health intermediaries Palmetto GBA, Cahaba GBA and United Government Services are affected since those intermediaries all use the same claims system. Associated Hospital Service of Maine uses a different system, so its providers aren't seeing the glitch.

Palmetto has about 5,000 claims suspended by the problem and Cahaba has 3,000 claims held up, representatives for the RHHIs tell Eli. UGS hasn't calculated the number of claims affected, a UGS official says.

Most of the suspended claims appear to be from October 2002 and later. When the system suspends them, it uses error code E6101, CMS says.

The glitch doesn't affect all claims that list supplies. "The specific circumstances that cause the error are not yet fully known," CMS says.

While the processing error doesn't hit 100 percent of claims reporting supplies, the problem occurs "in the majority of situations" where supplies are billed, according to the UGS source.

Since CMS doesn't even know what the problem is yet, a fix for it could be a long way off, warns Abilene, TX-based consultant and CPA Bobby Dusek. "It's a scary thought that they don't even know why it's happening," Dusek notes.

To clear up the backlog of suspended claims, RHHIs are removing the supply lines - which have no direct reimbursement - and are allowing them to process normally. Many claims will have interest due on the payments, CMS notes.

But from now until CMS corrects the problem, it will be HHAs' responsibility to deal with the glitch. The RHHIs will begin returning to provider the claims that suspend due to the supply error.

"All home health agencies should continuously check returned to provider (RTP) files for previously submitted claims that have been returned with reason code E6101," the National Association for Home Care & Hospice advises. Agencies then can remove the supply lines on the returned claims and resubmit them, CMS explains. Palmetto suggests using the Direct Data Entry (DDE) system to accomplish the change quickly.

Some HHAs might not see any returned claims, however, since the error seems hit and miss.

To avoid the problem altogether, agencies can cease reporting supplies charges on all claims until the glitch is fixed, CMS adds. But the agency discourages HHAs from taking this more drastic approach unless they have a high volume of claims that run into delays due to the predicament.

The problem with failing to report supplies charges is that CMS will use that data to set future prospective payment system rates. If HHAs just stop including supplies charges on their claims, CMS is likely to ratchet down PPS rates by that much, Dusek warns. While "it's good for agencies not to bill for supplies now, it will be bad later," he cautions.

NAHC urges agencies to keep their own internal records of supplies charges for each individual patient. CMS says after it fixes the problem, it will encourage agencies "to the extent practical to submit adjustments to the affected claims to restore the removed supply service lines in order for this data to be reflected in HH PPS claims data."

But many HHAs will be unlikely to use their precious time and resources to adjust claims for no immediate reimbursement, experts predict.

Worse yet, once agencies get in the habit of failing to include supplies charges on claims, they may continue to do so even after the glitch is resolved since it doesn't have a direct payment effect on them, Dusek worries. That omission will translate to lower PPS rates for everyone.