Dawn Hughes

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 […]

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

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

Each quarter, the Fiscal Intermediary Shared System (FISS) is updated to include new logic for claims processing, pricing, etc. When the release is installed, Palmetto GBA places a temporary hold to ensure the release is installed properly. During this time, claims with dates of service of January 1, 2021, or later will be held in

© 2020 Palmetto GBA, LLC We frequently update our articles to reflect the latest changes and updates to Medicare, and strongly recommend you visit this article at link below to confirm you have the latest version. Published Date:12/23/2020 Printed Date: 12/28/2020 URL: https://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~JM%20Home%20Health%20and%20Hospice~Articles~General~B open For the upcoming January 2021 Release, the Common Working File (CWF)

Palmetto GBA is excited to announce we have successfully implemented all enhancements to the 277CA report, as part of Smart Edits. Smart Edits is a process that returns pre-adjudicated claims information through claim acknowledgement transaction reports based on the Medicare 277CA. This system populates the STC*12 segment in the 2220D loop of the 277CA. Example

May 19, 2020 Retroactive to January 1, 2020, TRICARE manuals now include a Patient-Driven Groupings Model (PDGM) for Home Health Agency (HHA) reimbursement. Humana Military will release PDGM-reimbursed HHA claims with dates of service on or after January 1 as soon as system changes are implemented. TRICARE’s PDGM model TRICARE’s PDGM reimbursement model closely follows

For a beneficiary to participate in an Innovation Model or Demonstration, the beneficiary must first choose a participating provider to be their primary care physician. When accepting a referral for home health services, make sure to ask the referring physician if the beneficiary is currently participating in a Demonstration or Innovation Model. The referring doctor

Section 3708 of the Coronavirus Aid, Relief, and Economic Security (CARES) Act (Pub. L. No. 116-136) amended sections 1814(a) and 1835(a) of the Social Security Act to allow Nurse Practitioners (NPs), certified Clinical Nurse Specialists (CNSs), and Physician Assistants (PAs) to certify beneficiaries for eligibility under the Medicare home health benefit and oversee their plan

myNEXUS is proud to announce its partnership with Aetna to provide utilization management for home health services in Texas. Important Announcements Important COVID-19 Information:With the heightened international awareness regarding the coronavirus disease of 2019 (COVID-19), myNEXUS would like to provide important reminders for your agency. Please find the myNEXUS announcement regarding these reminders on business disruption, which