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

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Step 2: Submit a hardcopy (paper) adjustment to the rejected (R B9997) claim and include all theinformation regarding payment from the primary payer source. This includes the amountreceived as payment (if payment was received), the amount the provider is obligated to acceptas payment in full, and any deductible or coinsurance amounts that were applied. Foradditional information about submitting MSP information, refer to Cahaba’s “MedicareSecondary Payer (MSP) Billing: Quick Reference Tool at:https://www.cahabagba.com/rhhi/education/materials/quick_msp.pdfHardcopy (paper) claims and adjustments can be mailed to the following address:Cahaba GBAMedicare A ClaimsP.O. Box 9169Des Moines, IA 50306-9169Change Request 6426For additional information, you can find the official instruction (CR 6426) for this requirement by visitinghttp://www.cms.hhs.gov/transmittals/downloads/R70MSP.pdf on the CMS Web site. You will find theupdated Medicare Secondary Payer (MSP) Manual, (CMS Pub 100-05) Ch. 5 (Contractor PrepaymentProcessing Requirements), §40.7.3.2 (Medicare Secondary Payment Part A Claims Determination forServices Received on 837 Institutional Electronic or Hardcopy Claims Format) as an attachment to that CR.The related Medicare Learning Network (MLN) article is located at:http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6426.pdfChanges to Hospice Benefit Period Information on ELGA/ELGHThe Common Working File (CWF) has changed the ELGA/ELGH screens that display the hospice benefitperiod information. Effective January 4, 2010, ELGA/ELGH displays any applicable hospice periods thathave a termination date that is six months prior to the date entered in the ‘APP DATE’ field. If no date isentered, the ELGA/ELGH displays hospice periods that have a termination date that is six months prior tothe current date. As a result, if you wish to view current hospice benefit period information, you must entera future date (within 6 months) in the ‘APP DATE’ field.The following examples show information using the ELGH eligibility screen. The same results will displaywhen the ELGA eligibility screen is used.Home Health & Hospice February 1, 2010 43Medicare A Newsline Vol. 17, No. 5
Example 1: ABC Home Health is admitting a new patient and checks the ELGH screen for Medicareeligibility information. In this example, the current date is entered in the ‘APP DATE’ field. If the ‘APPDATE’ field is left blank, the same results will display.ELGH CWF PART A ELIGIBILITY SYSTEM ELGASAT101/08/2010 14:23:00 INQUIRY BY HOME HEALTH AGENCYENTER THE FOLLOWING FIELDS:HIC NUMBER : 123456789ASURNAME : SmithINITIAL : JDATE OF BIRTH : 01011920 (MMDDCCYY)SEX CODE : MREQUESTOR ID : 0011INTER NO : 00011NPI INDICATOR :N-NPI or BlankPROVIDER NO : XXXXXXHOST-ID : GL, GW, KS, MA, PA, NE, SE, SO, SWAPP DATE : 01082010 (MMDDCCYY)REASON CODE : 1RESPONSE CODE : PThe most recent hospice benefit period, 09/26/2009 – 11/24/2009 displays because the ‘TERM DATE’ of11/24/2009 is within 6 months prior to the current date of 01/08/2010, which was entered in the ‘APPDATE’ field.ELGH CWF PART A ELIGIBILITY SYSTEM ELGHCRO01/08/2010 14:23:33 HOSPICE INFORMATION PAGE 09 OF 09HOS-REC CN 123456789A NM SMITH IT J DB 01011920 SX MHOSPICE PERIOD 1 PERIOD 2 PERIOD 3 PERIOD PERIODSTART DATE 05/29/2009 07/28/2009 09/26/2009TERM DATE 07/27/2009 09/25/2009 11/24/2009PROVIDER NO XXXXXX XXXXXX XXXXXXINTER NO XXXXX XXXXX XXXXXREVOC INDNote in Example 1 (above) that a revocation indicator does not display in the ‘REVOC IND’ field.Therefore, it is possible that the beneficiary is still receiving hospice benefits. To determine if thebeneficiary is enrolled in a more recent hospice benefit period, you need to enter a future date in the ‘APPDATE’ field. Refer to Example 2.Home Health & Hospice February 1, 2010 44Medicare 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 and 42: When recording any visit or social
Page 43: Submit MSP Claims/Adjustments via:W
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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