Home Health Medicare Secondary Payer Claims are Being Overpaid

Current Status
6/26/2019: The FISS Maintainer implemented the fix on October 1, 2018. Palmetto GBA tested the fix and the claims that originally overpaid, paid correctly when adjusted. We are currently developing a process to capture and adjust claims that overpaid. No provider action is needed at this time.

Situation:
MSP Home Health final and LUPA claims (includes adjusted claims), TOB 32x, are being overpaid. The Medicare system is not recognizing the MSP payment information being reported in the Claim Adjustment Segments (CAS) and value codes on the claim.

Impact to Provider:
Overpayments have occurred on these claims. Providers should NOT submit voluntary refunds or report system issue overpayments on their Quarterly Credit Balance Reports for an ongoing system issue. The overpayments will be settled once the issue is fixed and the claims are able to adjudicate correctly.

Status:

6/26/2019
: The FISS Maintainer implemented the fix on October 1, 2018. Palmetto GBA tested the fix and the claims that originally overpaid, paid correctly when adjusted. We are currently developing a process to capture and adjust claims that overpaid. No provider action is needed at this time.

9/21/18: The FISS Maintainer will implement a fix on October 1, 2018. Once the fix is implement and verified, we will provide an update on how the improperly paid claims will be corrected. No provider action is needed at this time.

05/24/2018: CMS is aware of the issue, and there is no estimate as to when the issue will be resolved.

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