Hospices Experiencing Problems with Billings for Pumps
June 27, 2014 09:02 AM
Some hospices have been experiencing problems with billing of infusion pumps on claims, and those claims are being caught in suspension. NAHC and its affiliate Hospice Association of America (HAA) understands that the billing problems related to the pumps is a system-wide edit - in the Medicare Code Editor - that must be corrected by CMS.
HAA has learned from CMS that while the edit likely won’t be completely corrected until January 2015, they have in development a workaround that will allow the MACs to override and allow claims to process with the pumps. CMS will likely have more information on this issue by the next Open Door Forum.
While the date for the next Open Door Forum has not yet been published, the expected date is July 9.
Other billing issues for hospices that are arising relate to drugs and HCPCS codes. Apparently all of the MACs are experiencing varying issues with this because they have different HCPCS edits in their systems.
As these issues arise with these individual HCPCS codes, and claims go into suspension, the MACs are tracing the codes back and making changes.