The holiday season is coming with food, fun and family time ahead. However, billing must continue and claims must be sent as part of supporting the overall health of home health organizations.  The general decrease in workload due to lighter patient loads and absences from the office provides a little extra time to catch up on “housekeeping.”  Now is a good time to review old claims that have not been sent and adjustments that have not been completed or any other claim problems that have not been resolved. Clearing these problems up as well as continuing with current billing are enough to keep one busy, and keep everything current. Keep in mind to review claims for timely filing deadlines and get those claims completed and sent. The timely filing deadline for all claims is one year from the end of episode date for each claim.

For organizations that bill Medicare, the DDE system should be monitored frequently under the claims count summary for all status of claims. Especially review any claims that are in the Return To Provider (RTP) status. Claims with the RTP status are not being processed and will purge off the system in 60 days from submission. Most of the time, this type of bill can quickly be corrected online and re-submitted to the processing status. To find the reason code for the rejection open the claim and look in the bottom left hand corner on page 1 for the reason code. At this point click on the F1 key and this will show the written information for the reason code. Make the correction online in the claim and once the correction is completed, click the F9 key to put the claim back into the processing status.

Claims with the End of Episode (EOE) claim still outstanding should also be monitored for the auto cancel of the Request for Anticipated Payment (RAP). Remember a RAP will auto cancel if the EOE has not been submitted within 60 days of the paid date of the RAP or 120 days from end of episode, whichever is greater. If the RAP has auto canceled then billing for the claim must begin again with submitting the RAP, waiting 24 hours to submit the EOE if all components of the EOE are complete and ready for submission. A quick review of the components needed to bill an EOE:

1. All OASIS assessments required during the episode have been completed.
2. All regular visits completed. Visits not completed should not be billed
3. All Physician orders returned with signature and date.

Let’s not forget about the changes that have occurred with the new HIPAA 5010 version of the DDE system from June 30, 2012. There are three things in particular that may be causing your claims to be rejected:

1. Company zip code now needs the extended 4 digits for a total of nine digit zip code. Your software vendor should automatically take care of this for you.
2. Billing provider address must be a physical address as no PO Box addresses will be accepted.
3. National Provider Identifier (NPI) must be listed again with your company information. Previously a company was allowed to report an Employer’s Identification Number (Tax ID) or Social Security Number (SSN) as a primary identifier for the billing provider. Now with the HIPAA 5010 version only claims with the allowed NPI as a primary identifier will be needed for processing the claims.

The Fiscal  Intermediaries are an excellent resource for problem solving with your claims and they will also have closure dates for the holidays for their live support lines. However, the Interactive Voice Response (IVR) systems should be up and running and may be a help as well. The holiday closure dates for the intermediaries are as follows:  November 22-23, 2012 for Thanksgiving; December 24-25, 2012 for Christmas and December 31, 2012 & January 1, 2013 for New Year’s.

For your convenience I have listed the four different intermediaries’ phone numbers and web link below. Just click on the links and this will take you to the home page for the intermediary that services your agency. The websites contain useful tools and information for providers to keep up with the last CMS news and claim issues that other agencies may be having. It is recommended to sign up on the e-mail list for automatic updates to be sent directly to your e-mail inbox.  Also, if you are not sure of the intermediary that serves your state, enclosed is a diagram listing each state under the current MAC (Medicare Administrative Contractor).

Palmetto GBA:

Toll Free Phone number: 1-800-Medicare (1-800 633-4227) TTY: 877-486-2048

http://www.palmettogba.com/

NGS:  National Government Services

Toll Free Phone number: 1- 877-273-4334

http://www.ngsmedicare.com/

Anthem HP:

Phone number: They have selected phone numbers for each state they serve so please visit the website and then select the phone number for the state your agency is located in.

http://www.anthem.com/medicare

CIGNA:

Phone number: Home Health Complex Inquiries 1-877-299-4500

http://www.cgsmedicare.com/