CMS reports home health claims processing problem - Policy Watch - Brief Article

Healthcare Financial Management, April, 2003

A problem in the Medicare claims-processing systems of the Palmetto, Cahaba, and UGS regional home health intermediaries (RHHIs) is preventing some home health PPS claims from being processed appropriately, CMS reported on February 28. Affected claims 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 often does not equal the reported total-charge amounts and the claims receive a code E6101 edit. The specific circumstances that cause the error are not yet known.

For home health agencies experiencing this problem, CMS offers two options: submit claims in the normal manner and respond to any claims that get the edit by removing the supply lines and resubmitting the claims, or temporarily remove supplies codes from the claims (CMS recommends this option be used only if a high volume of claims is 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 so these will be reflected in home health PPS claims data. RHHIs and CMS will notify providers when this error is corrected.