Home Health & Hospice Week

Problem: Under the new 12-month rule, the Medicare claims system uses the date in the "through" field on an HHA claim to determine the filing deadline. But because requests for anticipated payment (RAPs) have to have the same "from" and "through" dates, RAPs were getting rejected as untimely, preventing timely final claims from being able to process. (For more details, see Eli's HCW, Vol. XX, No. 11, p. 87.)

Solution: The Centers for Medicare & Medicaid Services "has instructed Medicare contractors to bypass the enforcement of timely filing on RAPs," CMS says in an e-mail message to providers. If this problem has already affected your claims, you'll have to get in touch with your contractor for relief. "Cases have already occurred in which a RAP was incorrectly rejected as untimely and a timely-submitted final claim for the same episode was returned to the provider due to the lack of a corresponding RAP on file," CMS explains. "In some cases, these final claims are now past the timely filing deadline."

Take action: "CMS has determined that an administrative error exception to the timely filing requirement applies in these cases," the agency says. "Home health agencies affected by these cases should bring them to the attention of their Medicare contractors, who will bypass timely filing for these claims so they may be processed."

The National Association for Home Care & Hospice "applauds CMS for working to correct the situation," it says. CMS originally told NAHC a solution wouldn't be available until October.

While the fix is good, having to contact contractors for individual claims "is a very big hassle," says billing expert M. Aaron Little with BKD inSpringfield, Mo. "We are hoping that the intermediaries/ MACs will be cooperative in working with us and the provider community in working around this error, but it's too soon to know."

The problem has been causing major difficulties for some providers. "This has been causing significant challenges to any provider trying to get older claims billed and paid," Little says. Some providers "have been trying since the first of the year to get at-risk episodes billed, but have been unable to do so because of this error."