iQIES Issues with Auto-Generated Reports

This message is to inform you that iQIES users are currently experiencing issues when attempting to open the auto-generated reports, including the Final Validation Reports. We are actively working to resolve this issue immediately. In the meantime, users may request the user-requested Final Validation Report, but users may find that these reports are taking longer than usual to load. If you have any further questions, please contact our QIES/iQIES Service Center at 1-800-393-9313 or email us at iqies@cms.hhs.gov

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iQIES Issues with System Generated Final Validation Reports

This message is to inform you that iQIES is currently experiencing issues with the system generated final validation reports. This could include a delay in receiving your system generated final validation report or the inability to open the system generated final validation report. As a workaround, please manually request your final validation report. Our team is working to resolve this issue immediately. We will send an update as soon as the issue has been resolved. You can also check for updates on the iQIES Known Issues log: https://iqies.cms.gov/known-issues/. If you have any further questions, please contact our QIES/iQIES Service Center at 1-800-393-9313 or email us at iqies@cms.hhs.gov.

Home Health Payment Corrections

On April 1, Medicare systems will correct three errors affecting the payment of Calendar Year (CY) 2021 claims:

  • Claims spanning January 1 are applying CY 2020 rates in error
  • Late Request for Anticipated Payment (RAP) penalties are not applying to outlier amounts
  • Late RAP penalties are being applied after the Value-Based Purchasing (VBP) adjustment, when the VBP adjustment should be the last calculation

Over the next several weeks, Medicare Administrative Contractors will reprocess these claims to correct your payments. You don’t need to take any action.

Last Updated: 03/18/2021

RESOLVED: Home Health: Reason Code U5391, Fields on the Requests for Anticipated Payments (RAPs) and Final Claim Information Do Not Match

RESOLVED: Home Health: Reason Code U5391, Fields on the Requests for Anticipated Payments (RAPs) and Final Claim Information Do Not Match

Home Health: Reason Code U5391, Fields on the Requests for Anticipated Payments (RAPs) and Final Claim Information Do Not Match

Current Status

Date

Resolved

2/17/2021

Status: When agencies use the new exception from MLN/CR 11855 and submit RAPs with the first day of the period of care as the service date on the 0023 line for subsequent periods in CY 2021, the corresponding claim must be submitted with the same 0023 line date. The service dates on 0023 of the RAP and claim must match.

Provider Action: Providers shall enter the same service date on the 0023 line from the RAP to the corresponding claim 0023 line and return the claim for processing. Agencies should ensure the additional items detailed in reason code 38107 also match.

Open

2/8/2021

Status: Palmetto GBA is researching the editing of Reason Code U5391 for appropriateness, which is returning home health claims to the agency

Provider Action: If a RAP has processed, ensure the statement “from” date, admission date, HIPPS code, line item date for the HIPPS code (if not reporting the first day of the period on the RAP in CY 2021) and provider number on the claim match the RAP. No provider action is necessary at this time. We will provide updates when applicable.

Issue Description

Reason Code U5391 is editing on home health claims.

The reason code states:

One of the following fields on the final (TOB 329 or 339) do not match to the RAP.

1)  statement “from” date

2)  admission date

3)  HIPPS code

4)  line item date for the HIPPS code (0023 revenue line date)

5)  provider number

This issue may be caused by the CY 2021 changes in MLN 11855, which allows line item date for the HIPPS code to be the first day of the period of care as the service date on the 0023 line.

38107 1st day not of period not matching final claim 0023 line

RESOLVED: Home Health: Reason Code 38107: Fields on the Requests for Anticipated Payments (RAPs) and Final Claim Information Do Not Match

Home Health: Reason Code 38107: Fields on the Requests for Anticipated Payments (RAPs) and Final Claim Information Do Not Match

Current Status

Date

Resolved

2/17/2021

Status: When agencies use the new exception from MLN/CR 11855 and submit RAPs with the first day of the period of care as the service date on the 0023 line for subsequent periods in CY 2021, the corresponding claim must be submitted with the same 0023 line date. The service dates on 0023 of the RAP and claim must match.

Provider Action: Providers shall enter the same service date on the 0023 line from the RAP to the corresponding claim 0023 line and return the claim for processing. Agencies should ensure the additional items detailed in reason code 38107 also match.

Open

2/4/2021

Status: Palmetto GBA is researching the editing of Reason Code 38107 for appropriateness, which is returning home health claims to the agency.

Provider Action: Please ensure a RAP has processed for the billing period. If a RAP has processed, ensure the statement “from” date, admission date, HIPPS code, line item date for the HIPPS code (if not reporting the first day of the period on the RAP in CY 2021) and provider number on the claim match the RAP. No provider action is necessary at this time. We will provide updates when applicable.

Issue Description

Reason Code 38107 is editing on home health claims.

The reason code states:

A HH final (TOB 329 or 339) is being processed and a HH RAP (TOB 322 or 332)
Does not exist.

or

One of the following fields on the final (TOB 329 or 339) do not match to the
RAP

1)  statement “from” date

2)  admission date

3)  HIPPS code

4)  line item date for the HIPPS code (0023 revenue line date)

5)  provider number

This issue may be caused by the CY 2021 changes in MLN 11855, which allows line item date for the HIPPS code to be the first day of the period of care as the service date on the 0023 line.

Medicare Claims Spanning 2020-2021 Incorrect Claim Payments

Home Health: Claims Spanning 2020-2021 Not Applying Correct 2021 Payment Rate

Home Health: Claims Spanning 2020-2021 Not Applying Correct 2021 Payment Rate

Current Status

Date

Open

2/11/2021

Status: The system maintainer and CMS are aware of this issue.

Provider Action: No provider action is necessary at this time. We will provide updates when applicable.

Issue Description

The CY 2021 HH PPS payment rates should apply for periods with claim statement ‘Through’ dates on or after January 1, 2021. The system is incorrectly applying CY 2020 HH PPS payment rates for claims spanning 2020-2021.

Home Health Reason Code 37253 – Claims Returned to Provider (RTP) Due to OASIS Assessment Not Found

Current Status: Open

Date: 1/11/2021

Status: This issue is being resolved by the MACs and iQIES. Palmetto GBA will reprocess claims incorrectly Returned to Provider (RTP) for the missing OASIS information (reason code 37253).

Provider Action: No provider action is necessary at this time. We will provide updates when applicable.

Issue Description: The MACs did not receive the OASIS file responses from iQIES from 1/4/2021 through 1/8/2021, which may cause claims received or processed during this time period to RTP.

Home Health Reason Code 37253