Tag: claims

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. […]

RAP issue will require new step from agencies to avoid claim denial

Agencies are receiving new guidance from Medicare Administrative Contractors (MACs) to address one of several issues that have caused erroneously rejected RAPs and claims since the start of the year. For second period RAPs that have been submitted early, as allowed under the new RAP rules, you will want to make sure the 0023 line […]

CMS creates resource page for hospice VBID

CMS has created a special online resource page for the hospice Value-Based Insurance Design (VBID) demo. This page relays key information related to the model, including: an overview, coverage information, participating plans, billing and payment information, outreach and education and frequently asked questions. CMS is testing the inclusion of the Part A Hospice Benefit within […]

OIG: Medicare overpaid HHAs nationally $191.8 million in audit period

A recent OIG report suggests that the MACs could be recouping money they believe was incorrectly paid for home health episodes that ended with five to seven visits, slightly above the LUPA thresholds in PPS. And they could be enforcing stricter oversight of periods just above new LUPA thresholds in PDGM. Twenty out of 25 […]

CMS announces ADR limits updates

CMS has announced that the additional documentation requests (ADR) limits have undergone some changes and will now feature two significant updates. These changes will be effective starting April 15. The first update affects the percent of claim type that the Recovery Auditor can review. Each limit is based on the provider’s Medicare claims volume from […]