Tag: MACs

Latest system issue incorrectly identifies NOAs as duplicates

CMS’ Medicare Administrative Contractors (MACs) have alerted providers to a new system issue with the Notice of Admission (NOA). The NOA replaced the RAP in 2022 as the way for an agency to note it is the primary home health provider for a patient at the start of care. According to the MACs, an issue […]

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 […]

Guidance for MACs expected to address payment error

CMS recently published a new change request to provide Medicare Administrative Contractors (MACs) with guidance on new LUPA add-on amounts for occupational therapy visits under new regulations in the home health final rule. The change request also addresses system issues with the payment grouper process. With the start of PDGM in 2020, all home health […]

MACs again address HIPPS code confusion

Due to a number of inquiries about HIPPS code requirements, Medicare Administrative Contractor CGS is reminding providers of a change under PDGM that has impacted no-pay RAPS and final claims in 2021. The issue is a HIPPS code required for the RAP. It can be any valid HIPPS code, but the code used on the […]

MACs reminding agencies of RAP exception rules

Exceptions are allowed for RAPs approved outside of the five-day window in 2021, but agencies should include information in the remarks field indicating the reason the RAP was late, according to Medicare administrative contractor CGS. Since January 1, 2021, agencies have five days from the start of care to get the RAP approved by their […]

MACs announce RAP workaround due to error message

An issue with RAP processing under the new no-pay RAP policies has led to some RAPs being returned to agencies, but Medicare Administrative Contractors (MACs) have determined a workaround, according to a message from CGS to providers last week. While its optional for you to report a Core-Based Statistical Area (CBSA) code using value code […]

Identity theft, hospice aggregate cap liability among updates to Medicare Program Integrity Manual

CMS has released updates to the Medicare Program Integrity Manual. The updates include changes to the chapter of the manual focused on coordination between Medicare Administrative Contractors (MACs) and Unified Program Integrity Contractors (UPIC) when hospice aggregate cap liabilities are involved. CMS also updated the identify theft protections and victimized provider process section. The changes were […]

New change request outlines rebuttal process for providers with deactivated Medicare billing

CMS has issued a change request outlining the rebuttal process for providers or suppliers whose Medicare billing has been deactivated. CR 10978 provides instruction to Medicare Administrative Contractors (MACs) to advise providers of rebuttal rights and how to receive and process rebuttals. The change request takes effect Dec. 31, 2019. Providers can submit a rebuttal […]

Agencies out of compliance with quality reporting program requirements to receive notification letters

Home health agencies found out of compliance with the Home Health Quality Reporting Program (HHQRP) will soon receive notification from CMS.  Non-compliance will affect agencies’ CY2020 annual payment update. Medicare Administrative Contractors (MACs) mailed non-compliance notifications Oct. 1. The notifications are also available in agency CASPER folders as of Oct. 1. The agencies that receive a […]

MACs to hold two webinars about referrals and documentation

By Home Health Line. Part A/B and home health Medicare Administrative Contractors (MACs) are collaborating to hold two webinars Dec. 12 about home health referrals and clinical documentation requirements. The webinars will be held 11 a.m. to 12:30 p.m. EST and 3 p.m. to 4:30 p.m. EST. Among the topics slated for discussion: an overview […]