Claim Adjustments for Home Health A/B MAC Shift of Payments

Current Status
2/6/2019: Palmetto GBA is adjusting the approximately 9,000 claims that did not have the shift occur, but should have. The purpose of the adjustments is to shift the payment fund value codes from A to B (or vice versa). The Type of Bill (TOB) for the adjustments is 32G and the remarks will state "A/B SHIFT." These adjustments will take at least 90 days to complete, at which time this article will be updated. No provider action is required.

Situation:
The shift of payment for home health claims was not working as designed. Home health agencies' (HHAs) payment amounts were not affected by this issue, only how the payment was split (if applicable) on the claim.

The system was designed that once the final payment for an episode is calculated, the Medicare claims processing systems will determine whether the claim should be paid from the Medicare Part A or Part B trust fund. This A-B shift determination will be made only on claims, not on request for anticipated payments (RAPs). Value codes for A and B visits (value codes 62 and 63) and dollar amounts (64 and 65) may be visible to HHAs on electronic claim remittance records, but providers do not submit these value codes.

Status:
2/6/2019: Palmetto GBA is adjusting the approximately 9,000 claims that did not have the shift occur, but should have. The purpose of the adjustments is to shift the payment fund value codes from A to B (or vice versa). The Type of Bill (TOB) for the adjustments is 32G and the remarks will state "A/B SHIFT." These adjustments will take at least 90 days to complete, at which time this article will be updated. No provider action is required.

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