Tag Archives: home health billing

How is the ICD-10-CM Code Set Different from ICD-9-CM?

ICD-9 codes have between three and five characters, and with the exception of “V” and “E” codes, are exclusively numeric.  The fourth or fifth character is utilized for greater specificity and combinations of diagnoses are coded separately.  One example is … Read Full Post

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Palmetto RAP Suppression:

Palmetto GBA plans to suppress RAP payment to home health agencies with a large number of auto-cancelled RAPs.  Here is an excerpt from their most recent communique: “Providers are given the greater of 120 days after the start of the … Read Full Post

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Temporary Delay in Implementing Ordering and Referring Denial Edits

Due to technical issues, the implementation of the Phase 2 ordering and referring denial edits is being delayed.  These edits would have checked claims for an approved or validly opted-out physician or non-physician.  If either of these were missing or … Read Full Post

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CMS is holding some provider payments

The Centers for Medicare & Medicaid Services (CMS) has identified technical issues with certain parts of the April 2013 quarterly systems release.  For claims with dates of service or “through dates” on or after April 1, 2013, the issues affect … Read Full Post

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Home Health Services Require Ordering Provider’s NPI

To receive payment for home health services, any Medicare-enrolled Home Health Agency must file claims containing the name and National Provider Identifier (NPI) of the physician who ordered the service. When billing for an ordered home health service: The individual physician … Read Full Post

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Latest ADR Update as of 02/22/2012 – Jurisdiction 11- Home Health and Hospice

Palmetto GBA conducts probe reviews on services provided by Medicare providers within Jurisdiction 11. These reviews are in an effort to prevent inappropriate payments. Data analysis is performed at regular intervals to determine the types of services or providers that … Read Full Post

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Resolution of the 5010 Electronic Claims Submission 496 Edit

Jurisdiction 11 Home Health and Hospice With the implementation of Accredited Standards Committee (ASC) X12 Version 5010, the Medicare Administrative Contractors (MACs) have received a large increase in calls from billers regarding the 496 edit, more commonly referred to as … Read Full Post

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How to Navigate the Medical Review Projects

Jurisdiction 11 Home Health and Hospice FAQs: Additional Medical Review Projects and CERT To help reduce the Comprehensive Error Rate Testing (CERT) program error rates, Palmetto GBA was recently funded by CMS to undertake additional medical review projects that involve … Read Full Post

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Increased Claim Scrutiny!

Palmetto GBA is performing a variety of medical review activities in addition to the reviews discussed in the next article. As part of our normal medical review process, we perform ongoing data analysis and identify services and providers for medical … Read Full Post

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Home Health Prospective Payment System Rate (HH PPS) Update For Calendar Year (CY) 2012

Policy Updates for CY2012 1) Market Basket Update: The home health market basket percentage increase for CY 2012 is 2.4 percent. After reducing it by 1 percentage point as required by the Affordable Care Act, the CY 2012 HH PPS … Read Full Post

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