February 1, 2010, Home Health & Hospice Medicare A ... - CGS
February 1, 2010, Home Health & Hospice Medicare A ... - CGS February 1, 2010, Home Health & Hospice Medicare A ... - CGS
Reason for CallClaim rejectedbecause ofbeneficiaryeligibility recordNumber ofCallsPrior to Calling Cahaba:1,686 Check ELGH/ELGA screens prior to submitting claims to Medicare.For assistance in updating the beneficiary’s name, Medicareentitlement dates, or date of death, contact the Social SecurityAdministration at 1-800-772-1213.Medicare Advantage plan enrollment dates:• Contact individual MA plan to update incorrect dates• Submit services to MA Plan, if Option Code “C” on ELGH pg. 5or ELGA pg. 1, and no hospice election impacts dates of service(DOS)Medicare Secondary Payer records:• Contact the Coordination of Benefits Contractor (COBC) at 1-800-999-1118 to update records• If date(s) of service overlap an MSP record:• Submit claim to primary insurance, if appropriate• Submit Medicare claim with MSP information (see the resourceslisted above for assistance with Medicare MSP claims)NOTE: RAPs/NOEs are always submitted with Medicare as theprimary payerIf the dates of service on your home health final claim fall outsideepisodes posted to beneficiary record, review the information on theCorrecting Home Health Episode Information Posted to the CommonWorking File (CWF) Web page.For additional information for home health providers, see theResolving Rejected Home Health Claims Caused by Billing ErrorsWeb page.If incorrect dates were posted for a hospice benefit period provided byyour hospice facility, see the Canceling a Notice of Election or BenefitPeriod Web page.*Source of information, the Medicare Contractor Beneficiary and Provider Communications Manual (Pub.100-9, Chapter 6)Home Health & Hospice February 1, 2010 49Medicare A Newsline Vol. 17, No. 5
Availability of the Provider Contact Center (PCC)Medicare is a continuously changing program, and it is important that we provide correct and accurateanswers to your questions. To better serve the provider community, the Centers for Medicare & MedicaidServices (CMS) allows the provider contact centers the opportunity to offer training to our customer servicerepresentatives (CSRs). Listed below is the date and time the home health and hospice PCC (1-877-299-4500 and 1-866-539-5592) will be closed for training. We will continue to notify you of future CSRtraining dates in the Home Health & Hospice Medicare A Newsline.CSR Training DateFebruary 15, 2010 (Federal Holiday)Time8:00 a.m.—4:30 p.m. Central TimeNews from Cahaba for Hospice ProvidersReminder of Physician Narrative and Attestation Requirement on HospiceCertificationsAs a reminder, the August 6, 2009, Federal Register mandated that hospice certifications/recertificationsmust now include a brief narrative by the certifying physician to explain their clinical findings that supportthe patient’s life expectancy of six months or less. The narrative shall include a statement under thephysician signature attesting that by signing, the physician confirms that he/she composed the narrativebased on his/her review of the patient’s medical record, or if applicable, his or her examination of thepatient. The narrative must be composed by the same physician that signs the certification/recertification.Our Medical Review Department has informed us that many hospices are complying with the use of thephysician narrative requirement; however, the attestation statement is missing. Our Medical Review staffwill deny hospice claims which do not include this attestation statement on the narrative for thecertification/recertification. Therefore, ensure your hospice agency has implemented the necessary steps toinclude the attestation statement on narratives for your certifications and recertifications. For moreinformation about this requirement, please view the “Reminder – New Hospice Certification/RecertificationRequirements” article on page 28 of the October 1, 2009, Medicare A Newsline, or the “HospiceCertification/Recertification Requirements” Web page.Home Health & Hospice February 1, 2010 50Medicare 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 and 44: Submit MSP Claims/Adjustments via:W
- Page 45 and 46: Example 1: ABC Home Health is admit
- Page 47 and 48: Before You Call Cahaba, Read This!F
- Page 49: Reason for CallClaim needingcorrect
- Page 53 and 54: Cahaba GBA Learning Corner‣ “Ho
- Page 55 and 56: Cahaba GBA Learning Corner‣ “OA
Availability of the Provider Contact Center (PCC)<strong>Medicare</strong> is a continuously changing program, and it is important that we provide correct and accurateanswers to your questions. To better serve the provider community, the Centers for <strong>Medicare</strong> & MedicaidServices (CMS) allows the provider contact centers the opportunity to offer training to our customer servicerepresentatives (CSRs). Listed below is the date and time the home health and hospice PCC (1-877-299-4500 and 1-866-539-5592) will be closed for training. We will continue to notify you of future CSRtraining dates in the <strong>Home</strong> <strong>Health</strong> & <strong>Hospice</strong> <strong>Medicare</strong> A Newsline.CSR Training Date<strong>February</strong> 15, <strong>2010</strong> (Federal Holiday)Time8:00 a.m.—4:30 p.m. Central TimeNews from Cahaba for <strong>Hospice</strong> ProvidersReminder of Physician Narrative and Attestation Requirement on <strong>Hospice</strong>CertificationsAs a reminder, the August 6, 2009, Federal Register mandated that hospice certifications/recertificationsmust now include a brief narrative by the certifying physician to explain their clinical findings that supportthe patient’s life expectancy of six months or less. The narrative shall include a statement under thephysician signature attesting that by signing, the physician confirms that he/she composed the narrativebased on his/her review of the patient’s medical record, or if applicable, his or her examination of thepatient. The narrative must be composed by the same physician that signs the certification/recertification.Our Medical Review Department has informed us that many hospices are complying with the use of thephysician narrative requirement; however, the attestation statement is missing. Our Medical Review staffwill deny hospice claims which do not include this attestation statement on the narrative for thecertification/recertification. Therefore, ensure your hospice agency has implemented the necessary steps toinclude the attestation statement on narratives for your certifications and recertifications. For moreinformation about this requirement, please view the “Reminder – New <strong>Hospice</strong> Certification/RecertificationRequirements” article on page 28 of the October 1, 2009, <strong>Medicare</strong> A Newsline, or the “<strong>Hospice</strong>Certification/Recertification Requirements” Web page.<strong>Home</strong> <strong>Health</strong> & <strong>Hospice</strong> <strong>February</strong> 1, <strong>2010</strong> 50<strong>Medicare</strong> A Newsline Vol. 17, No. 5
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