Some payments for home health providers received by the Centers for Medicare & Medicaid Services (CMS) Healthcare Integrated Ledger Accounting System (HIGLAS) for processing for cycle dates from July 7, 2009 through July 9, 2009, may have been paid incorrectly due to the installation of the July release. Home health Request for Anticipated Payment (RAP) and Low Utilization Payment Adjustment (LUPA) claims and adjustments where the original or adjustment amount ended in zeroes were truncated, and the zeroes were dropped from the payment calculation. This has resulted in underpayments and some overpayments on claims processing for payment. The problem has been identified and was corrected on July 11, 2009 to prevent future occurrences.
Claims that were placed in the approved to pay location prior to the installation of the fix will pay at the incorrect amount. All future claims will be paid correctly. CMS is aggressively working to identify and calculate the payment differences on all impacted claims. A process to issue payments to providers is being developed by CMS with the highest priority, with an expected completion date on or about July 31, 2009. The corrected payments for the home health original claim underpayments will be issued on or about July 20, 2009, followed by corrected payments for the adjusted claim differences on or about July 31, 2009.
Impact to Providers
All amounts due will be issued as non-claim payments and appear with your normal remittance advice. Some claims on payments during the timeframe referenced above were underpaid and some adjustments were overpaid. The claim details related to these claim payments will be reported correctly within the remit, however, the payment difference will appear in the ‘Adjust to Balance’ field. There is no action required by providers regarding this issue, since CMS will be issuing corrected payments to all impacted providers.
Friday, July 17, 2009
Tuesday, July 14, 2009
OASIS – C Posted for Review
Draft OASIS-C has been posted by CMS for review. The final version of the new OASIS-C is expected within the next few months with a roll-out date of January, 2010. CMS expects the OASIS User’s Manual to be updated in September, 2009 and will contain detailed guidance on the use of OASIS-C.
Non-Clinician and Patient’s First Home Health Visit
If nursing services are ordered, federal regulations require the initial assessment visit to be performed by an RN and to be performed by a qualified therapist if services other than nursing services are ordered. Therefore, a non-clinician is prohibited by federal law from visiting the patient to collect patient identifying OASIS information regardless of the home health services ordered.
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