Home Health and Hospice Data Analysis Report: Claims Submission Error and Provider Inquiry for January 1 through June 30, 2021

Published 09/01/2021

Claims submission errors are those that result in rejected, denied or incorrectly paid claims. Palmetto GBA maintains a provider data analysis program that lists the most frequent collective claims submission errors from all providers in our Jurisdictions. The analysis includes common and inadvertent clerical or administrative errors and other types of errors that could be prevented through outreach and education. Data analysis includes identification of aberrancies in billing patterns within a homogeneous group, or detection of patterns within claims or groups of claims.

The Jurisdiction M Home Health and Hospice (HHH) top ten claim submission errors for January 1, 2021 through June 30, 2021 are:

HHH Rank

Denial Code

Count of Claims with Denial Code

Percent of Denied Claims to Total Claims with any Denial Code

1

31947

67,393

19.9

2

38200

61,374

18.2

3

38157

50,463

14.7

4

U538I

23,560

7.0

5

U5233

19,281

5.6

6

38158

14,444

4.3

7

C7010

12,943

3.7

8

39929

11.044

3.1

9

U538F

10,909

3.3

10

39011

7,511

2.2

All Medicare Administrative Contractors use the Centers for Medicare & Medicaid Services instructions to classify or categorize provider inquiries. Palmetto GBA maintains a provider inquiry analysis program to identify frequently asked questions (FAQ) beyond claims status and eligibility for telephone and written inquiries.

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Palmetto GBA uses the results of the inquiry analysis program to train Provider Customer Service Program (PCSP) staff and provide education to address the needs of our provider community. The top HHH inquiry FAQ resources are listed below:
 

Frequently Asked Questions (FAQ)


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