| Situation | Impact to Providers | Status |
Incorrect payments.
This issue was reported to the Centers for Medicare & Medicaid Services (CMS) and the FISS maintainers on 11/06/2009. |
Home health partial episode payment (PEP) claims are receiving incorrect payments. |
11/19/2009 - This issue will be corrected with a system fix scheduled for March 1, 2010. |
Home Health Claims are Returning to Providers (RTP) with the reason code 38107. This 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 was reported on 07/13/2009. |
The system cannot find a processed RAP that corresponds to the Final claim. |
11/19/2009 - Currently the workaround for this issue requires providers to write the Provider Contact Center at the following address and request the claim be canceled.
Palmetto GBA
RHHI Provider Contact Center
Mail Code: AG-620
P.O. Box 100238
Columbia, SC 29202-3238
Providing a spreadsheet of your affected claims will be appreciated. Please include patient's name, HICN and Date of Service. Once the claim is canceled, the provider should resubmit the claim to Palmetto GBA for processing.
The expected system fix remains scheduled for January 2010.
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Hospice adjustment claims are receiving reason code 31949 - A denial reason code is being used and the reason code status is set to an “s” on the reason code file.
because prior to the 10/5/09 release, hospice claims with revenue codes 55x, 56x, and 57x were processing with charges listed as non-covered with reason code 34928-For 81X or 82X type of bill, statement from date on or after 01/01/08 and revenue code 055X, 056X, or 057X is present on the claim. A fix went into production with CR6386 which mandated that these charges should be covered.
This issue was reported on 10/07/2009. We are working to resolve the situation. |
Hospice claims that have been adjusted or returned to provider corrections made by the provider will receive this reason code unless providers correct the lines and bill them as covered charges prior to submitting the claim to us. |
11/19/2009 - A system fix has been developed and is currently being tested. |
On payments dated June 5th through June 12th, some providers experienced delays in claims payments due to FISS claim number assignment issues. This problem was corrected on June 11th. Providers impacted by the issue should have seen payments appear on their remits beginning June 15th. An additional problem has been identified after the installation of the fix on June 11th. Although the payment amount is included on provider checks/EFT's, as well as in the payment amount on the remittance advice, the claim detail is not present on the remittance advice. This is creating a situation where an amount equal to the total reimbursement amount of the missing claims is appearing in the adjust to balance field. It is anticipated that once this issue is corrected, the claim detail will appear on the remittance advice following the date the fix is installed. Since providers have already received payment for these claims, the reimbursement amount for these claims will not be included in the providers payment amount on that remittance advice. This will again cause an amount equal to the total reimbursement for these claims to appear in the adjust to balance field on the remit.
This issue was reported on 06/26/2009 and we are currently waiting on the FISS maintainer to evaluate this problem and create a systems fix. |
Providers are receiving payments, however the remittance advice detail will not balance to the payment amount. |
11/19/2009 - We are currently working with the Data Center to resolve.
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Reason Code U538F is editing incorrectly on adjustment (e.g., 3XG) bill types.
This issue was first reported to FISS and CMS on 03/26/2009. Update on 09/24/2009 - Reason Code U538F is no longer editing incorrectly on adjustment bill types. Providers should continue to check the log for information pertaining to claims currently affected. We are waiting on the FISS maintainer on this fix. |
Adjustment impacted by this situation are currently suspended in SMRADJ or SMU538. Claims are not processing. |
11/19/2009 - A system fix has been developed and is currently being tested.
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