Transcript Medicare Home Health Billing Updates from CGS
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%)
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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%
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Inquiry Triage Process Source of Information: CMS Pub. 100-09, Ch. 6, § 30.1
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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
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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
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• ‘HH Quick Resource Tools’ Page www.cgsmedicare.com/hhh/education/materials/ HH_QRT.html
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‘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