Wiki Medicare denials of G0180 and G0179 HELP ME!!

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cgneff72

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Medicare is denying all of our Home Health Certs and Re-certs (G0180 / G0179) with different denial reasons:

***Medicare denied stating not covered in this place of service. (We billed with POS 11)

***Medicare denied stating missing/incomplete/invalid Home Health Certification period. (Should I be entering the cert period dates somewhere on the claim??)


Any help would be greatly appreciated!!!
 
What dates are you using for the lines?
We are having the same problem too.
I would like to know what you find out as well.
Thanks
Melissa Gulledge, CMA, CPC
 
We are using the date the provider signs the certification as the date of service. I am wondering if we should be including the certification period dates somewhere on the claim - but I can't find any documentation that says that.
 
Add Home Health agency as location

Billing POS of service 11 is correct. You can bill the date the physician signs the order or the start date of the home health services. Since most of our patients go on home health straight from inpatient services, we always bill the date that the physician signs the certificate to avoid any date overlap. Medicare also needs the NPI of the Home Health Agency. We use the actual home health agency as the location on claims. There is an AAPC article "Take a Closer Look at Care Plan Oversight" that helped me tremendously.

Hope this helps
Latosha Cooley, CPC, CPMA
Assistant Office Manager
Atlanta Clinical Care, PC
 
Last edited:
Block 23

cgneff72 said:
What field (on the CMS-1500) do we enter the Home Health Agency's NPI??
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The claim form (HCFA-1500) must include the home health agency’s six-digit Medicare provider number in Block 23. The provider number is located in Locator #5 of the HCFA-485 (top right corner).

Latosha Cooley, CPC, CPMA
Assistant Office Manager
Atlanta Clinical Care, PC
 
HHC convoluted question

Ok, if we bill the date the doctor signs off on the Home Health Certificate form, as the date of the claim, how do we handle if the patient passes away before she actually signed on the dotted line, (for a time period starting at the beginning of the month)? My Supervisor states the Date of service for the claim should be the start of the plan coverage, IE: 4/1/18. Dr signed 4/25 and patient passed 4/21. Need proof to take to supervisor. Thank you
 
Are you a provider based billing practice? Location code I use and always get reimbursed for G0180 is location 22. Always remember to put in the provider number for the agency. I do not bill for G0179 as it always gets denied.

Hope this helps
 
alisac said:
Are you a provider based billing practice? Location code I use and always get reimbursed for G0180 is location 22. Always remember to put in the provider number for the agency. I do not bill for G0179 as it always gets denied.

Hope this helps
Click to expand...

Yes, Local Wound Care center- I bill for the Doctor not facility (POS 19) As long as it is over the 60 day window G0179 is paid. My problem is the Dr signed off after the patient had passed. Can I use another date?
 
mjstack said:
HHC convoluted question

Ok, if we bill the date the doctor signs off on the Home Health Certificate form, as the date of the claim, how do we handle if the patient passes away before she actually signed on the dotted line, (for a time period starting at the beginning of the month)? My Supervisor states the Date of service for the claim should be the start of the plan coverage, IE: 4/1/18. Dr signed 4/25 and patient passed 4/21. Need proof to take to supervisor. Thank you
Click to expand...
DOS is the date of death. I have billed like this and got paid. Also I have never included the HH NPI on the claim and all my HH claims are paid.
 
Hi, I'm getting denial on CPT G0180 with Anthem blue Cross saying that according to health plans bundled services & supplies policy, this service supply or item is not eligible for reimbursement and also modifiers do not override. I called and asked for Guideline, but they said CMS guideline. Now I'm confused. can anyone explain. Thanks!

Vasanthi Ramineni
 
Hi, I'm getting denial on CPT G0179 Superior Health plan stating as Cpt G0179 denied has Missing/incomplete/invalid procedure. Could you please advise what we can do to work on this claim. Thanks!
 
From my understanding, G0180 is a Medicare-only code. The Commercial payer code would be 99374-99375, however, I've been told Blue Cross will not pay this either.
 
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