Medicare Compliance & Reimbursement

Sit tight for adjustments, Medicare Administrative Contractors instruct. Home care providers hoping for a smooth transition to ICD-10 have seen their cash flow disrupted by Medicare claims system glitches.

Latest problem: “Claims with dates of service that span into October 2015, with correct ICD-10 diagnosis codes, are receiving reason code 31276; however, the Fiscal Intermediary Standard System (FISS) edits as if the claim is prior to October 1, 2015, and includes ICD-10 codes,” described Home Health & Hospice Medicare Administrative Contractor CGS in a message to providers.

For the rejections, “the reason code narrative states ‘Outpatient claim contains an ICD-10 indicator of 9 and an ICD-10 diagnosis is present,’” HHH MAC Palmetto GBA says on its website.

The solution: After the problem was discovered, MACs began “suspending these claims, including those already rejected/returned to providers,” Palmetto says. “MACs are currently manually processing these suspended claims upon receipt, bypassing the edit causing the problem, until a system fix is implemented. No provider action is required.”

CGS expected the system fix to go into place the week of Oct. 19. At press time, the MACs had not issued confirmation of a successful fix.

Plus: CGS has announced a fix to a previously announced claims system error in which providers’ NPIs “fall off” the crosswalk. The MAC expects a fix to be in place by Oct. 26. “Please note that the [FISS] is unable to assign a PTAN, therefore, providers are unable to see the RAPs, NOEs and claims affected by this issue in their RTP file,” CGS explains. “In addition, in some instances, claims are rejecting when a batch transfer is submitted.”

The ICD-10 problem, combined with other slow-downs, is taking a serious toll on providers’ cash flow, reports billing expert M. Aaron Little with BKD in Springfield, Mo. “So far this month payments have been very delayed,” says Little, who hopes “it’s just a temporary disruption.”