Tag: claims

Home health agency to pay $2.1 million in DOJ settlement

A home health agency has paid $2.1 million to settle claims of improper billing for services provided to patients in Florida, according to an announcement May 5, 2022, by the U.S. Attorney’s Office in the Western District of Kentucky, where the agency is headquartered. According to a complaint filed in the United States District Court […]

NOA discharge error resolved, reports NGS

NGS, a Medicare administrative contractor serving agencies in 19 states, reports to its providers that there has been a resolution for the months-long issue with Notices of Admission that was causing a return to provider incorrectly with edit code U537F. The error was due to the Common Working File not correctly recognizing discharges, according to […]

Guilty plea in home health kickback scheme

Federal prosecutors claim five South Florida home health agencies are linked to an alleged scheme involving kickbacks and bribes in exchange for Medicare referrals for services the patients did not need and, in many cases, never received, according to a release from the Department of Justice’s Southern District of Florida. On Friday, Ernesto Espinosa, 71, […]

CMS adds two new responses to the RCD FAQs

With a February update to the Review Choice Demonstration (RCD) frequently asked questions, CMS addresses questions about claims not subject to RCD and notes that number of visits does not matter when it comes to RCD. From the updated FAQ: Are any claims exempt from the RCD process?  Home health claims for Veteran Affairs, Indian […]

New issue impacting third-party NOA submissions

Medicare Administrative Contractors (MACs) are alerting providers to a system error impacting the new Notice of Admission (NOA) when submitted through an Electronic Media Claim (EMC) software provider. National Government Services, a MAC serving providers in 19 states, issued an “urgent” alert Jan. 5, 2022, noting the issue with ZIP codes submitted on EMC claims […]

Hospice pays $500,000 after allegedly failing to recertify terminal illness

After it self-disclosed conduct, an Alabama-based hospice provider agreed to pay $500,000 for allegedly violating the Civil Monetary Penalties Law, according to a release from the Department of Health and Human Services Office of Inspector General (OIG). OIG alleged that the hospice submitted claims to Medicare for hospice services that lacked recertifications of terminal illness, […]

MACs announce fix for HIPPS code payment error

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 […]

Medical reviews begin for pandemic claims

Medicare Administrative Contractors (MACs) have resumed post-payment medical reviews on claims during the public health emergency, according to Palmetto GBA and the latest MLN Connects newsletter. Since August, MACs have limited medical reviews to claims with dates of service before March 2020. “MACs may now begin conducting post-payment medical reviews for later dates of service,” […]

Preview of Things to Come? Lawsuit Challenges Employer’s COVID-19 Vaccine Mandate

Access to COVID-19 vaccines continues to expand in the United States, and employers are navigating many questions about employee vaccinations and return to work. Current polling shows a substantial number of workers are hesitant about getting the shots or may refuse to be vaccinated against the virus. Now, a New Mexico employee has filed what […]

Latest RAP-related claims error involves placeholder HIPPS code

Some agencies are facing new payment issues related to the no-pay RAPs that began January 1, 2021. MACs Palmetto GBA and CGS, collectively responsible for claims in 31 states, have recently alerted agencies to a potential issue where Medicare’s system is sometimes not replacing the placeholder HIPPS code used to match RAPs and final claims. […]