Medicare Administrative Contractors (MACs) have addressed a payment error impacting some claims that were tied to the generic HIPPS code used on RAPs.
The HIPPS code on the RAP is only used by the CMS system to pair RAPs with the final claim. Under PDGM, the CMS payment system is expected to determine the actual HIPPS code used for payment, regardless of the HIPPS code on the RAP and claim.
Earlier this year, MACs alerted agencies to the error where the system paid some claims based on the generic HIPPS code without determining a claim-specific code.
On June 8, Palmetto GBA updated its claims error log to note a system fix has been implemented to correct the issue.
For providers in its states, Palmetto GBA said those paid with the incorrect HIPPS code can submit an adjustment to the claim with the D9 Condition Code and add “REMARKS” stating the “Claim originally paid with the incorrect HIPPS Code.”
CGS also noted its providers should add “REMARKS” indicating the claim originally paid with the incorrect HIPPS code.