Medicare will be retiring G Code G0154 for Home Health and Hospice.  Beginning for Hospice date of service on or after January 1, 2016 and for Home Health episodes ending on or after January 1, 2016, agencies will need to report new G/HCPCS Code G0299 for “Direct skilled nursing services of a Registered Nurse- RN in the Home Health or Hospice Setting”.  Agencies will need to use new G/HCPCS Code G0300 to report “Direct skilled nursing services of a Liscensed Practical Nurse-LPN in the Home Healt or Hospice setting.

Agencies must have Main Office Software version 5854 dated 10/28/15 prior to initiating new G Code set up in the software.

Agencies currently using different service codes for RN and LPN visits can update the HCPCS field with the new G code.

Agencies that do not currently differentiate in services between RN and LPN visits will need to update their current Skilled Nursing Visit service to reflect the RN visit and enter the new RN G Code in the HCPCS field.  Agencies will then need to add a new service for the LPN Skilled Nursing Visit using the new G code for services by an LPN in the HCPCS field.  The Service or Revenue code remains the same for both visits and unchanged from previously required 0551.

When invoicing Medicare Home Health and Hospice, the software will look at the date of the visits being reported.  If the date of service is prior to January 1, 2016, the software will replace the new G Codes with Go154.  When invoicing for dates of service on or after January 1, 2016 the software will use the new G codes already attached to the visits by complying with the previously detailed set up instructions.

ADDITIONAL IMPORTANT SERVICE SET UP TO CONSIDER:

Agencies using the Service Billing Rate tab for both Medicare and other Commercial Insurance billing codes and rates will need to add medicare in the Insurance Company Rates tab grid with the new G code/HCPCS with the original revenue code and billing rate.  The new G code is required specifically for Medicare Home Health and Hospice.  Agencies should contact their commercial insurance or Medicare Advantage/ HMO plans to verify if any changes are required for those payers.

Agencies that have Medicare or Medicare Hospice already entered in the Insurance Company Rates tab will just need to update the existing record.  A new record line for Medicare or Medicare Hospice should NOT be added.

Upon investigation CGS has also indicated claim processing issues and rejections for Final claims whose episode spanned  October 1, 2015.  CGS indicated any previously submitted claims that are currently listed in RTP for the  agency can be sent through for manual processing by selecting F9.  Any claims currently submitted will be manually processed by CGS and no further action will be required by the provider.

Palmetto has issued a notice regarding claim processing issues for Claims that spanned October 1, 2015.  Below is a direct quote from Palmetto.  It has been reported to Allegheny Software that claims are receiving the same Reason code from CGS.  We are currently  researching this report and what provider action is needed.

JM Home Health and HospiceClaims Payment Issues Log

HOME HEALTH ICD-10 REASON CODE 31276

Impact to Providers:
Palmetto GBA is researching home health (HH) final claims (type of bill 32X) with a THROUGH date on or after the October 1, 2015, that are incorrectly returning to the provider (RTP) with reason code 31276. The reason code narrative states “Outpatient claim contains an ICD-10 indicator of 9 and an ICD-10 diagnosis is present”.

Medicare Learning Network Articles SE1408 and SE1410 state that “Medicare requires the use of ICD-10 codes on HH claims and Requests for Anticipated Payment (RAPs)” with a THROUGH date on or after the October 1, 2015.

Status:
10/15/2015:
Home health claims with episodes that span October 1, 2015, are being incorrectly rejected/returned to providers. Medicare Administrative Contractors (MACs) are suspending these claims, including those already rejected/returned to providers. MACs are currently manually processing these suspended claims upon receipt, bypassing the edit causing the problem, until a system fix is implemented. No provider action is required; however, contact your MAC if you have questions.

10/14/2015: This issue is in research. Palmetto GBA will update this CPIL as soon as additional information is available.

Agencies will need Main Office software version 5838 dated 10/9/15 or later before paper or ansi 5010 claims are generated using the ICD 10 format check box for services provided  10/01/15 or after, for patients who have a 485/Plan of Care  entered in the software where the certification  period crosses the October 1, 2015  time point and the agency did not populate the ICD 10 transitional code fields in the 485 and is using either the Transitional ICD10 tab or ICD 10 Patient Diagnosis screen.  The software has been updated to pull the Transitional ICD 10 or  ICD 10 codes to the Invoice/Claim.

A new PECOS file is now available for download

Agencies will need Main office software version 5833 dated 10/7/15 when creating OASIS xml files for  OASIS C1 ICD 10 assessments.  OASIS xml files created for OASIS C1 ICD 10 assessments prior to version 5833 may receive fatal errors.  XML files may be recreated and submitted to CMS following the version update.

Agencies submitting Hospice claims will need to mark the check box found on the ANSI 5010 Billing screen, “use 2015 Transition CBSA Codes” when generating Hospice claims starting October 1, 2015 to pull the transitional CBSA codes to their hospice claims.

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