Home Health & Hospice Week

Return your claims denied for W7048 for processing.

Don’t be surprised if any — or all — of these recent claims glitches are putting a dent in your payments.

Problem No. 1: “The Home Health Medicare Administrative Contractors (MACs) are aware of some home health claims receiving reason code 19963 in error,” HHH MAC Palmetto GBA says in an Aug. 23 post to its Claims Payment Issues Log webpage. “This is occurring when the NOA is more than 18 months received by Medicare and have gone offline to OB9997 status/location,” Palmetto explains.

Solution No. 1: Home health agencies will have to sit tight for now. “We are researching this issue and working with CMS/FISS,” HHH MAC CGS reports on its CPIL webpage. “We will update providers as more information becomes available,” it pledges.

You can, however, “ensure [the] claim is editing in error as described as some claims will appropriately edit for RC 19963,” CGS suggests.

Problem No. 2: An issue plaguing hospice claims has been reason code W7048. “This reason code states one or more visit revenue codes were reported on the claim without the required corresponding HCPCS code,” Palmetto describes. For example, “claims were being incorrectly returned with W7048 when General Inpatient Care (GIP) and Respite stays are reported with service location HCPCS code Q5006 (inpatient hospice facility) and there is no HCPCS code reported with discipline visits that occurred during the inpatient stays,” the MAC says. “If the visits are within the inpatient service dates, they do not require a corresponding visit HCPCS code,” the MAC emphasizes.

Solution No. 2: The claims processing system update in October is scheduled to fix this error. In the meantime, MACs will “suspend hospice claims that edit for RC W7048 to bypass the edit and release them back in to processing,” Palmetto and CGS report.

“Hospices who have had claims returned with RC W7048 since July 1, 2023, should return them for processing so they may bypass RC W7048,” the MACs instruct. “If a hospice had a claim(s) returned prior to July 1, 2023, ensure the correct HCPCS codes were applied to the claim,” they add.

Problem No. 3: “Some home health claims returned to the provider (RTP’d) with reason code 32103 due to an NPI Crosswalk issue,” CGS says in its log. “This issue occurs when an historical termination date is incorrectly applied in FISS after an application finalizes in PECOS under a current, active enrollment record.”

Solution No. 3: Again, agencies must wait. “A resolution is pending further research,” CGS informs providers. “You may continue to submit NOAs (TOB 32A) to meet the timely filing requirement, but don’t submit claims or correct/resubmit any NOAs or claims that RTP until the issue is resolved,” the MAC advises.