Medicare Claim Processing Issues at CGS

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.

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Medicare Claim Processing Issues with Palmetto

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.

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Update for Generating Invoices and ANSI 5010 claims

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.

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PECOS

A new PECOS file is now available for download

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OASIS C1 ICD 10 XML files

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.

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Transitional CBSA Codes Required for Hospice Claims

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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ICD 10 Transition and Updated Instructions

Agencies will need to obtain Main Office Software version 5824 dated 9/29/2015 and Clinical Point of Care Software version 2364 dated 9/29/15.  The ICD 10 Instructions found on the main menu screen have been updated.  Previous instructions included direction for two different OASIS and PPS billing scenarios.  The update will include directions for additional OASIS and PPS billing scenarios in the form of a billing chart.

Please note,   Start Of Care episodes with a Start of Care date 9/27 thru 9/30 and a M0090 date as the date the assessment was completed as 10/1/15 or later will need to be in ICD 10 format.  These assessments will need ICD9 Billing Override codes populated for RAP billing.  ICD 9 Billing Override codes data entry fields may be found in Edit PPS billing screen for the assessment or in the Changes button for the assessment that can be found in the View screen.   Recertification assessments completed (M0090 date) 9/27/15 thru 9/30/15 whose certification period is 10/1/15 or later will need to be in ICD 9 format.  The ICD 10 Transition codes will need to be completed for these Recertification assessments and will be used for RAP and Final claims.

Please monitor Allegheny messages for notification of software version updates over the next week as we continue with the transition to ICD 10 to ensure your agency software is updated to accommodate any additional programming changes.

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Updates Are Available to Correct Access Violation Errors

Agencies who received an Access Violation Error when opening the Demographics section of Comprehensive Assessments in the software will need the most recent software update.  The Main office software version dated 9/23/15 is 5820.  The Clinical point of Care software version dated 9/23/15 is 2360.

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PECOS

A new PECOS file is available for download.

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ICD 10 Instructions

ICD 10 Instructions are now available from a button located on the Main Menu screen of HHC 3000 with verion updates dated 9/1/2015 or later.

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