February 1, 2010, Home Health & Hospice Medicare A ... - CGS

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• Data on claims for chaplains/spiritual counselors or volunteers will not be collected at this time, butreporting of this data will be in a future phase of the data collection.• For general inpatient (GIP) care, the reporting of visit intensity data is not required at this time.Providers should continue to report the number of GIP visits in accordance with CR 5567. Additionally,the units for visits under GIP level of care continue to reflect the number of visits per week, and visitreporting by non-hospice staff is exempted when hospice patients in a contract facility are receivingGIP.Additional InformationYou can find more information about the additional data collection requirements on hospice claims by goingto CR 6440, located at http://www.cms.hhs.gov/Transmittals/downloads/R1738CP.pdf on the CMS Website. You will find the updated Medicare Claims Processing Manual, Ch. 11 (Processing Hospice Claims),§30.3 (Data Required on Claim to FI) as an attachment to that CR.If you have questions regarding this issue, refer to the “Contact Us” page of our Web site and select“Telephone Us” to call the Provider Contact Center.Disclaimer This article was prepared as a service to the public and is not intended to grant rights or impose obligations. Thisarticle may contain references or links to statutes, regulations, or other policy materials. The information provided is onlyintended to be a general summary. It is not intended to take the place of either the written law or regulations. We encouragereaders to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of theircontents.News from Cahaba for Home Health and Hospice ProvidersClarification on Submitting Medicare Secondary Payer (MSP) Claims/AdjustmentsThe following provides clarification about submitting MSP claims/adjustments according to therequirements provided in Change Request 6426, effective October 5, 2009. Previous information wasprovided to you in e-mail messages dated September 30 and October 9, 2009, and in the November 1, 2009,Home Health & Hospice Medicare A Newsline.BackgroundChange Request (CR) 6426 requires that CAS segments be submitted on MSP claims and adjustmentswhere the primary insurance had made a payment. CAS segments are not utilized when MSP claims andadjustments are entered directly into the Fiscal Intermediary Standard System (FISS) via Direct Data Entry(DDE) environment. The following provides additional clarification in regard to how to submit MSPclaims/adjustments in certain MSP situations.Home Health & Hospice February 1, 2010 41Medicare A Newsline Vol. 17, No. 5
Submit MSP Claims/Adjustments via:When:FISS DDE • Services are unrelated to an open MSP record (liability,workers’ comp, no-fault, etc.)• The primary insurance denied payment.Electronically (i.e., a billing software inthe American National Standard Institute(ANSI) ASC X12N 837 4010-A1 format(e.g., PC-Ace Pro32 v. 2.14))PaperNote: If your facility does not have awaiver due to meeting the small providerexception, (CMS Pub. 100-04, Ch. 24,§90), see the instructions below underthe “Unable to Submit ClaimsElectronically” header.• Claim is for services where another insurer has made apayment.• Claims where another insurer is primary, and there is apossibility/expectation that the primary insurer willmake a payment in the future. Example, services arerelated to a liability record; however, there was no promptresponse/payment (within 120 days) from the primaryinsurer after submitting your claim to them.• Claims where the primary insurer applied the chargesto the deductible.• Claims where the beneficiary has coverage throughBlack Lung. Refer to Cahaba’s Federal Black Lung (BL)Program Web page for additional information.Important Reminders• Correcting MSP Claims and AdjustmentsIf an MSP claim/adjustment was submitted electronically, and is returned to provider (RTP) (status/locationT B9997) for correction, you must resubmit the claim electronically. If you correct the claim via FISSDDE, the claim/adjustment will receive reason code 31265 and will remain in the RTP file.• Verify Required Data Entered Based on Claim’s Type of Bill (TOB)To avoid needlessly resubmitting an MSP claim numerous times, it is important that providers verify that allrequired claim data is present for the type of bill they are submitting (example, home health final claim orhospice claim), and that the information (including the required MSP claim data) is complete and correct.• Unable To Submit Claims ElectronicallyIf you are unable to submit claims electronically using the 837 format:Step 1: Submit a claim via FISS DDE showing Medicare as the primary payer. This will result in theclaim being rejected.Please be aware that claims may reject to FISS status/location (S/LOC) R B75XX or R B9997.If your claim rejects to an R B75XX S/LOC, it will remain there for at least 75 days. Providerswill be unable to submit an adjustment to a rejected claim until it moves to a finalized R B9997S/LOC.Home Health & Hospice February 1, 2010 42Medicare A Newsline Vol. 17, No. 5
Page 7: use and while they may serve other
Page 10: The following additional billing re
Page 13 and 14: APPENDIX 1TABULAR PRESENTATION OF T
Page 15 and 16: News from CMS for Home Health Provi
Page 17 and 18: Provider Types AffectedHome health
Page 19 and 20: • For CY 2010, Medicare is modify
Page 21 and 22: procedures since 2005, continue to
Page 23 and 24: methodology. The services are paid
Page 25 and 26: NOTE: When billing for stranded sou
Page 27 and 28: c. Other Changes to CY 2010 HCPCS C
Page 29 and 30: d. Drugs and Biologicals with Payme
Page 31 and 32: separately payable status under the
Page 33 and 34: CY 2010 APCCY 2010 APC Title0395 GI
Page 35 and 36: CY 2010 APC CY 2010 APC Title0375 A
Page 37 and 38: m. Pricer will update the payment r
Page 39 and 40: If you have questions regarding thi
Page 41: When recording any visit or social
Page 45 and 46: Example 1: ABC Home Health is admit
Page 47 and 48: Before You Call Cahaba, Read This!F
Page 49 and 50: Reason for CallClaim needingcorrect
Page 51 and 52: Availability of the Provider Contac
Page 53 and 54: Cahaba GBA Learning Corner‣ “Ho
Page 55 and 56: Cahaba GBA Learning Corner‣ “OA

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