Fiscal Intermediary Standard System Claims Processing Issues

Home Health

NA

The Home Health Payment Totals Inquiry screen (FISS Inquiry Option 67) continues to have problems implementing Change Request 7395. 

The quarterly outlier reconciliation process will not be run until the issues are resolved.

5/9/2012—The resolution is now tentatively scheduled for May 7, 2012.
3/29/2012—This issue has been reported to the FISS maintainers and to the Centers for Medicare & Medicaid Services.  A resolution to this issue is tentatively schedule for June 4, 2012. 

Home Health Requests for Anticipated Payments (RAPs)

U6815 and 34378

FISS is incorrectly looking for Medicare Secondary Payer (MSP) information on home health RAPs. 

RAPs are continually cycling through FISS with reason codes U6815 and 34378.

3/29/2012— CGS staff is currently researching this issue. 

Hospice

NA

The Other Physician information is being dropped from hospice claims submitted via the X12 Version 5010.

Claims are processing without this information.  Providers should continue to submit this information. 

5/9/2012—
CMS issued Change Request 7755 which requires hospices to report the certifying physician (when different than the attending physician) in the referring physician 2310F loop on the 837I version 5010A2. The implementation date for this CR is October 1, 2012.
3/29/2012—CGS staff is currently researching this issue. 

Home Health and Hospice

31313

The Release of Information code (form locator 52) is missing from claims submitted via the X12 Version 5010 when Medicare is the secondary payer.

Claims are being sent to the Return to Provider (RTP) file with reason code 31313.  Because these MSP claims and adjustments cannot be corrected from the RTP file, providers need to submit a new claim on paper, or wait until the issue is resolved before resubmitting the claim.    

3/29/2012—This issue has been reported and a resolution is tentatively scheduled for the June 4, 2012, system release.

Home Health and Hospice

U5106, U538F, U5600, U6006

This issue was caused by missing claim responses from the Common Working File (CWF).

Home health and hospice claims are being suspended to status/location S M5600 with reason codes U5600 and U6006.

Hospice Notice of Elections (NOEs) and home health Requests for Anticipated Payments (RAPs) are being sent to the Return to Provider (RTP) file with reason codes U5106 (NOE) and U538F (RAPs).

3/29/2012—The NOEs (U5106) and RAPs (U538F) that were sent to RTP have been moved to the status/location S MMADR.  CGS staff is working these NOEs and RAPs to allow them to continue processing.  No provider action is necessary.

3/12/2012— At this time, no date of resolution has been established.

2/7/2012—CGS staff are working to move claims out of status/location S M5600 and moving NOEs and RAPs out of RTP.  Although some NOEs and RAPs are in RTP (status/location T B9997) appropriately with reason codes U5106 and U538F, providers should refrain from working NOEs, and RAPS with these reason codes out of their claims correction file at this time.

5/9/2012— This issue has been resolved. NOEs and RAPs have been released and are processing. 
If providers feel they are receiving an NOE or RAP with this reason code in error, please contact the CGS Provider Contact Center (Home health -877-299-4500 or Hospice 866-539-5592).

Hospice

31411

Some hospice claims with non-covered charges are receiving reason code 31411 incorrectly.  Reason code 31411 ensures that the occurrence span code is submitted with the correct type of bill. 

Claims affected by this issue are suspended in status/location S MNEWR.

5/9/2012—The resolution to this issue is scheduled for a 09/04/12 production date.
3/29/2012— At this time, no date of resolution has been established.
1/20/2012—This issue has been reported to the FISS maintainer. 

Hospice

NA

Hospice nurse practitioner services (revenue code 0657) are being paid incorrectly.  FISS is paying this service at 85% of the lesser of the actual charge or the Medicare Physician Fee Schedule (MPFS) amount.  FISS is also applying the 85% to the submitted charge.  The payment should be the lesser of 85% of the MPFS or 100% of the submitted charge.

Providers submitting hospice claims with nurse practitioner services (revenue code 0657) are being reimbursed incorrectly.

3/12/2011—The Change Request 7677 clarifies payment of nurse practitioner services as the lower of the submitted charge or 85% of the physician fee schedule.  The resolution to this issue is scheduled for the July 2012 system release. 

10/28/2011—The Centers for Medicare & Medicaid Services (CMS) will add a requirement to correct the NP payment to an upcoming Change Request (CR) which is currently planned for the July 2012 release.

Home Health

C7121

Home health claims with line item dates of services that occurred 3 days prior to an inpatient admission are receiving reason code C7121 in error. 

Until a resolution to this issue is implemented, outpatient claims with reason code C7121 are being held in status/location
S M90CW.

10/28/2011—A resolution to this issue is scheduled for the April 2012 release. 

10/12/2011—At this time, no date of resolution has been established.

10/5/2011—This issue has ben reported to the Common Working File (CWF).

5/9/12—
The resolution to this issue was implemented with the April release.

Hospice

Although the Point of Origin, (previously known as source of admission code) is required to be entered in the SRC field (form locator 15), hospice providers are unable to access the SRC field in the Fiscal Intermediary Standard System (FISS). 

FISS has disabled the edit that requires that a Point of Origin code is entered into the SRC field; therefore, claims are processing as usual.  However, once the resolution is implemented, the edit will be activated. 

1/20/2012—It is anticipated that the resolution to this issue will be implemented in the June 2012 system release.

12/8/2011— At this time, no date of resolution has been established.

9/23/2011—This issue has been reported to the FISS maintainer.

Hospice

U5181

Some hospice claims are inappropriately receiving reason code U5181 when occurrence span code 77 and noncovered dates are submitted, regardless of whether a new benefit period is created for the dates of service being billed.

Research shows that this issue usually occurs on the 2nd claim being submitted.

2/7/2012— No further update.
1/20/2012—CWF is unable to determine if this issue is still occurring.  Therefore, providers should PF9 any claims that are in the Return to Provider (RTP) file with reason code U5181.  If the claim moves back to the RTP file, please call the Provider Contact Center at 1-866-539-5592.

12/8/2011— At this time, no date of resolution has been established.

06/22/2011—This issue has been reported to the Common Working File (CWF) for further research.

3/12/2012—This issue has been closed.  If providers receive reason code U5181 and feel it is inappropriate, please call the Provider Contact Center at 1-866-539-5592.