Home Health & Hospice Week

Claims system problem reminds agencies to always be prepared.

Without reimbursement coming in the door, you can’t pay your staff and meet other essential commitments. Home health agencies faced that scary prospect as Medicare scrambled to fix its claims system.

Problem: "The Centers for Medicare & Medicaid Services (CMS) identified technical issues with certain parts of the April 2013 quarterly systems release," multiple HHH Medicare Administrative Contractors said in messages to providers. "As a result of these issues, CMS instructed its Medicare claims administration contractors to hold several specific claim types until April 14, 2013, when system fixes were expected to be implemented."

But then Medicare didn’t hit that deadline. "These corrections are taking slightly longer to finalize than expected," the message acknowledged.

The delay to reimbursement was causing some hardship, related Lynn Olson, owner of Astrid Medical Services in Corpus Christi, Texas. "Mid-month payroll, quarterly employment tax," Olson observed.

Then the resolution date for home health claims was unclear. The claims system problem affected HHA claims and seven other types in hospital, outpatient, ESRD, and other settings. CMS said it expected all types of claims except those for HHAs to release April 17.

The hold was causing anxiety. "If the claims aren’t released very soon, then it will definitely begin to have a negative impact," billing expert M. Aaron Little with BKD in Springfield, Mo. told Eli.

Solution: But agencies were relieved when CMS unexpectedly went ahead and released HHA claims along with the other types April 17. At press time, HHAs were watching to make sure claims really did process according to the 14-day payment floor based on date of receipt.

Be prepared: It is for these types of situations that agencies must have cash reserves and access to credit, experts say.

No Guarantee of RAP Payment

Meanwhile, HHAs continue to see slow request for anticipated payment (RAP) payments, Olson tells Eli. "It seems they are now more consistent with the nine to fourteen days" for a RAP payment timeframe, he says.

Remember: MACs are under no payment deadline to process RAPs. "Home health Requests for Anticipated Payment (RAPs) and hospice Notice of Elections (NOEs) are not considered claims and thus, there is no specified timeframe for processing them," HHH Medicare Administrative Contractor CGS recently told providers (see Eli’s HCW, Vol. XXII, No. 13).

"We also have received the ‘tough cookie’ response," Olson notes.