Medicare Home Health Billing Updates from CGS

PHA Annual Conference – State College, PA

May 17, 2012

CGS Home Health Claims Data

Number of Home Health “Claims” Submitted

1,052,833

Total of Top 6 HH “Claims” Billing Error Reasons

83,455 (7.93%)

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November 1, 2011 – March 31, 2012

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Top Home Health Billing Errors

• Referred to as Claim Submission Errors (CSEs)• Results in RAPs/claims being rejected (R

BXXXX) or returned to provider (RTPd) (T B9997)

• Assigned 5-digit reason code which defines error

• Impact of CSEs» Creates additional work for billers» Costs agencies $$» Delays payment for services provided

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Top CGS Home Health Billing Errors

Reason Code

Error Caused By # of Errors

38107FISS can’t find matching RAP

44,372

38157/ 38200

Duplicate billing – same beneficiary/same dates of service/same billing provider

20,752

U538IOverlap another HHA’s episode

8,247

31755HIPPS code/LIDOS mismatch

5,404

31147HIPPS code/supply billing mismatch

4,680

November 1, 2011 – March 31, 2012

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• ‘Top Claim Submission Errors (Reason Codes) and How to Resolve’ web page, www.cgsmedicare.com/hhh/education/materials/CSEs.html» Lists most common errors by RC» Explains reason for error» Provides suggestions for how to

prevent/resolve

Top Home Health Billing Errors

Top HH+H Provider Inquiries

Number of Home Health/Hospice Provider Telephone Questions Handled

19,921

Sum of Top 5 Home Health/Hospice Inquiry Reasons

8,658

Percent of Total Inquiries 43.46%6

November 1, 2011 – March 31, 2012

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Inquiry Triage Process

Source of Information: CMS Pub. 100-09, Ch. 6, § 30.1

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Reason for Call

Type of Issues # of Calls

Billing Instructions

Instructions for submitting MSP claims, special billing situations, new billers

2,507

Provider Enrollment

RequirementsProvider enrollment revalidation 2,208

Claim Correction

Understanding reason code narrative; instructions for correcting RAPs/claims

1,949

Top HH+H Provider Inquiries

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Reason for Call

Type of Issues # of Calls

Claim Overlap

Beneficiary inpatient stay, overlapping HH PPS episodes/hospice benefit periods

1,006

Address, Phone, Fax, Web Address

CGS mailing addresses, links to information on CMS or CGS Web sites

988

Top HH+H Provider Inquiries (cont.)

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Provider Inquiry ‘Resources’www.cgsmedicare.com/hhh/education/materials/ Resources_Most_Common_HHH_Questions.html

List of links, information Review prior to contacting Updated quarterly Based on inquiry data

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CGS Website

• www.cgsmedicare.com

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• Primary links on left

CGS Website

• Quick links on right

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CGS Website • Primary linksPrimary Link

Information Available

News & Publication

Recent news, join/update listserv, CGS Bulletins, Cahaba’s Newslines

Claims Processing

Rates/fee schedules, checking claim status, FISS Claims Processing Issues, common FISS status/locations, RA/ERA, submitting paper claims

EDI PC Print, GPNet, PC-ACE Pro32, FAQs

Customer Service

Phone numbers, Mailing addresses, IVR User Guide, Website feedback, Duplicate remit form

Education Calendar of events, educational materials, FAQs, Advisory Group, new provider resources

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• Primary links (cont.)

CGS Website

Primary Link

Information Available

Enrollment Electronic funds transfer (EFT), Enrollment packets, revalidation

Financial Audits, cost reports, PS&R, credit balance form, rates/fee schedule

Appeals Levels of appeal, redetermination address, reopenings, resources

LCDs & Coverage

Active LCDs, home health and hospice coverage guidelines, OASIS

Medical Review

ADRs, Overview of MR (edits, reason codes), signature guidelines

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‘News & Publications’ Page

Current/recent ListServ

messages

CGS monthly newsletter

Cahaba Newslines

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Telephone

numbersMailing addresses

IVR Guide

Duplicate Remit form

‘Customer Service’ Page

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‘Events & Education’ Page

CGS Resources

Upcoming Events

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‘Educational Materials & Resources’ Page

Scroll down for provider-specific

resources

FISS Guide

MSP Resources

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• www.cgsmedicare.com/hhh/education/materials/index.html

Home Health Education Resources

‘Educational Materials & Resources’ Page

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‘HH Claims Filing’ Page

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‘HH Claims Filing’ Page

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‘HH Coverage Guidelines’ Pagewww.cgsmedicare.com/hhh/coverage/Home_ Health_Coverage_Guidelines.html

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• www.cgsmedicare.com/hhh/education/materials/HH_QRT.html

‘HH Quick Resource Tools’ Page

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‘FAQs’ Page

MSP FAQs

HH FAQs

Provider Enrollment FAQs

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‘LCDs & Coverage’ Page

HH PT LCD

HH Coverage

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‘Medical Review’ Page

ADR information

Signature requirements

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CGS Website Search EngineEnter search

term and click “Go”

• Accessible from top of each web page

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Online Provider Services (OPS)

• Coming soon!• Another means to:

» Check patient eligibility» Obtain claim status» View/order remittance advices (RAs)» Check payment floor status» Verify dates/amounts of last 3 Medicare

payments• Must have EDI Enrollment Agreement on file• Watch CGS Bulletins, listservs for more

details

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Questions

Home Health Provider Contact Center(877) 299-4500