Current Processing Issues for Home Health Medicare Claims

Posted Monday, January 24, 2022

NAHC became aware of home health claims processing problems in the last several weeks, caused by a CMS systems issue and some Medicare Administrative Contractor (MAC)-specific issues. (See January 12, 2022 NAHC Report for more information.)

NAHC quickly began addressing these issues when it was brought to our attention. The issues were:

  1. Notice of Admission (NOA) processing issues
  2. Erroneous editing for reason code 31755
  3. Claims being suspended for pricing verification

A fix for the issue where the zip code was being stripped from the NOA was due to be implemented by February 2. However, NAHC understands it has already been implemented and NOAs submitted this week are now processing as they should.

The MACs had previously provided NOA resources which included a job aid showing exactly which fields needed to be completed for submitting the NOA. This combined with the processing issues caused some confusion for providers because the job aid was for NOAs being submitted electronically only. Some of the claim fields that the job aid instructed providers to complete are not required and should not be completed when submitting the NOA via DDE (Direct Data Entry). Therefore, the MACs have split the job aid into two – one for NOAs being submitted electronically and one for NOAs being submitted via DDE.  This should help clarify for providers exactly what is needed for each.

Palmetto has had some additional issues with the NOA processing that were not experienced by NGS and CGS. However, the Palmetto Claims Payment Issues Log (CPIL) has been updated with all the issues and, at this time, there is no additional action providers need to take.

Home health agencies are reminded that if an NOA is late due to any of the systems issues, providers should request an exceptional circumstance by utilizing the KX modifier and including a description of the issue, including the associated reason code (if applicable). The MACs have indicated that the issues experienced do fall within the exceptional circumstance allowances.

Source: NAHC

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