An Update to Hospice Claims for Pumps from CGS
July 17, 2014 12:23 PM
Correction to Inappropriately Returned Hospice Claims — Hospices are required to report certain prescription drugs and durable medical equipment items, effective April 1, 2014; see MLN Matters® Article MM8358. Currently, some hospice claims reporting these items are being returned to providers in error. These claims are returned with reason codes W7061 and W7072.
CMS had directed Medicare Administrative Contractors (MACs) that process hospice claims to override these reason codes, so the claims will process appropriately. MAC implementation dates for this correction may vary, so hospices should check their MAC Website for the date to begin resubmitting the returned claims.
Note from CGS: Claims with reason code W7061 and W7072 are currently suspended in status location S M7061 and S M7072. Within the next two weeks, CGS will release these claims to continue processing.
It is important to note that CMS indicated during last week's Open Door Forum that the MACs may be implementing the fix in different time frames, so while CGS has provided a time frame Palmetto and NGS' time frames may be different.