An Update on Inappropriately Returned Hospice Claims for Pumps
July 21, 2014 02:37 PM
NAHC’s Hospice Association of America (HAA) recently posted an update from CGS about hospice claims that include ambulatory infusion pumps and their anticipated schedule for addressing the issue. For more, please see NAHC Report, July 17, 2014). Since then, another Medicare Administrative Contractor (MAC) has issued a notice that it, too, is addressing the issue.
The following is a notice from Palmetto that recently was posted to its website:
PALMETTO: Jurisdiction 11 Home Health and Hospice
Correction to Inappropriately Returned Hospice Claims: Reason Codes W7061 and W7072
Effective April 1, 2014, hospices are required to report certain prescription drugs and durable medical equipment items (MLN Matters® Article MM8358). It was found that some hospice claims reporting these items were being returned to providers in error.
The Centers for Medicare & Medicaid Services has directed Hospice Medicare Administrative Contractors (MACs) to override these reason codes so the claims will process appropriately.
Palmetto GBA implemented the override function on July 16, 2014. Hospices can now resubmit (PF9) their returned claims for processing.
It is important to note that CMS indicated during its most recent 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.