Medicare Home Health Billing Updates from CGS

PHA Annual Conference – State College, PA May 17, 2012

CGS Home Health Claims Data

November 1, 2011 – March 31, 2012

Number of Home Health “Claims” Submitted Total of

Top 6

HH “Claims” Billing Error Reasons

1,052,833 83,455 (7.93%)

2

Top Home Health Billing Errors • • • • Referred to as Claim Submission Errors (CSEs) Results in RAPs/claims being rejected (R BXXXX) or returned to provider (RTPd) (T B9997) Assigned 5-digit reason code which defines error Impact of CSEs » » » Creates additional work for billers Costs agencies $$ Delays payment for services provided 3

Top CGS Home Health Billing Errors

November 1, 2011 – March 31, 2012 Reason Code

38107 38157/ 38200 U538I 31755 31147

Error Caused By

FISS can’t find matching RAP Duplicate billing – same beneficiary/same dates of service/same billing provider Overlap another HHA’s episode HIPPS code/LIDOS mismatch HIPPS code/supply billing mismatch

# of Errors

44,372 20,752 8,247 5,404 4,680 4

• Top Home Health Billing Errors ‘Top Claim Submission Errors (Reason Codes) and How to Resolve’ web page, www.cgsmedicare.com/hhh/education/materials/CSEs.

html » Lists most common errors by RC » » Explains reason for error Provides suggestions for how to prevent/resolve 5

Top HH+H Provider Inquiries

November 1, 2011 – March 31, 2012

Number of Home Health/Hospice Provider Telephone Questions Handled Sum of Top 5 Home Health/Hospice Inquiry Reasons

19,921 8,658

Percent of Total Inquiries

43.46%

6

Inquiry Triage Process Source of Information: CMS Pub. 100-09, Ch. 6, § 30.1

7

Top HH+H Provider Inquiries

Reason for Call Type of Issues # of Calls

Billing Instructions Provider Enrollment Requirements Provider enrollment revalidation 2,208 Claim Correction Instructions for submitting MSP claims, special billing situations, new billers Understanding reason code narrative; instructions for correcting RAPs/claims 2,507 1,949 8

Top HH+H Provider Inquiries (cont.)

Reason for Call Type of Issues

Claim Overlap Beneficiary inpatient stay, overlapping HH PPS episodes/hospice benefit periods Address, Phone, Fax, Web Address CGS mailing addresses, links to information on CMS or CGS Web sites

# of Calls

1,006 988 9

Provider Inquiry ‘Resources’ www.cgsmedicare.com/hhh/education/materials/ Resources_Most_Common_HHH_Questions.html

 List of links, information  Review prior to contacting  Updated quarterly  Based on inquiry data 10

CGS Website • www.cgsmedicare.com

11

CGS Website • Primary links on left • Quick links on right 12

CGS Website • Primary links

Primary Link Information Available

News & Publication Recent news, join/update listserv, CGS Bulletins, Cahaba’s Newslines Claims Processing EDI Customer Service Education Rates/fee schedules, checking claim status, FISS Claims Processing Issues, common FISS status/locations, RA/ERA, submitting paper claims PC Print, GPNet, PC-ACE Pro32, FAQs Phone numbers, Mailing addresses, IVR User Guide, Website feedback, Duplicate remit form Calendar of events, educational materials, FAQs, Advisory Group, new provider resources 13

CGS Website • Primary links (cont.)

Primary Link Information Available

Enrollment Financial Appeals LCDs & Coverage Medical Review Electronic funds transfer (EFT), Enrollment packets, revalidation Audits, cost reports, PS&R, credit balance form, rates/fee schedule Levels of appeal, redetermination address, reopenings, resources Active LCDs, home health and hospice coverage guidelines, OASIS ADRs, Overview of MR (edits, reason codes), signature guidelines 14

‘News & Publications’ Page Current/recent ListServ messages CGS monthly newsletter Cahaba Newslines 15

‘Customer Service’ Page Telephone numbers Mailing addresses IVR Guide Duplicate Remit form 16

‘Events & Education’ Page Upcoming Events CGS Resources 17

‘Educational Materials & Resources’ Page FISS Guide MSP Resources Scroll down for provider-specific resources 18

• ‘Educational Materials & Resources’ Page www.cgsmedicare.com/hhh/education/materials/ index.html

Home Health Education Resources 19

‘HH Claims Filing’ Page 20

‘HH Claims Filing’ Page 21

‘HH Coverage Guidelines’ Page www.cgsmedicare.com/hhh/coverage/Home_ Health_Coverage_Guidelines.html

22

• ‘HH Quick Resource Tools’ Page www.cgsmedicare.com/hhh/education/materials/ HH_QRT.html

23

‘FAQs’ Page HH FAQs MSP FAQs Provider Enrollment FAQs 24

‘LCDs & Coverage’ Page HH PT LCD HH Coverage 25

‘Medical Review’ Page ADR information Signature requirements 26

• CGS Website Search Engine Accessible from top of each web page Enter search term and click “Go” 27

• • • • Online Provider Services (OPS) Coming soon!

Another means to: » Check patient eligibility » Obtain claim status » » » View/order remittance advices (RAs) Check payment floor status Verify dates/amounts of last 3 Medicare payments Must have EDI Enrollment Agreement on file Watch CGS Bulletins, listservs for more details 28

Questions Home Health Provider Contact Center (877) 299-4500 29