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 Hospice
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.