CMS reports home health claims problem
A problem in the Medicare claims processing systems of the Palmetto, Cahaba, and UGS Regional Home Health Intermediaries (RHHI) is preventing the appropriate processing of some home health prospective payment system (PPS) claims that include medical supplies (revenue codes 27x and 623). The systems are not adding the charges associated with service lines for medical supplies into the total charge amount on these claims. As a result, the sum of the line item charges does not equal the reported total charge amount, and the claims receive a code E6101 edit. The error does not occur consistently, and the specific circumstances that cause the error are not known. For home health agencies seeing this problem, the Centers for Medicare & Medicaid Services (CMS) offers two options:
1. Submit claims in the normal manner, and respond to any claims that get the edit by removing the supply lines and resubmitting the claims.
2. Temporarily remove supplies codes from the claims. CMS suggests this option only if a high volume of claims is being affected.
When the error is corrected, home health agencies will be asked to submit adjustments to the affected claims to restore the removed supply
service lines for the data to be reflected in home health PPS claims data. RHHIs and CMS will notify providers when this error is corrected.
Random unannounced survey topics identified
In a random unannounced survey (RUS) by the Joint Commission on the Accreditation of Healthcare Organizations in Oakbrook Terrace, IL, surveyors review fixed and variable performance areas, along with the variable topics based upon the organization’s last survey report. The fixed performance areas for home care that will be reviewed during RUSs in 2003 by the Joint Commission are as follows:
planning and provision of care;human resources management;
infection control;
patient assessment;
medication administration.
Approximately 5% of organizations accredited by the Joint Commission undergo a RUS each year.
CMS reports home health claims problem; Random unannounced survey topics identified.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content