Production Alerts

Details Status Reported / Resolved Provider Type Affected
Date Reported: 04/07/2021
Status: Open

HH+H LUPA Claims Rejection Error- Reason Codes 39929 and 37363

LUPA claims are rejecting in error with RCs 39929 (claim level) and 37363 (line level), indicating incorrectly that RAP claims have been submitted beyond timeliness limits.


 

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Open 1617771600000

J6 and JK HH+H providers

Date Reported: 06/22/2021
Status: Open

Part A DRG Weight-Claim Adjustment Error

Adjustment claims are receiving 37549 edit stating the DRG weight on the adjustment is greater than the DRG weight on the claim being adjusted.

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Open 1624338000000

Jurisdiction 6 and Jurisdiction K Part A Inpatient Hospital Providers

Date Reported: 07/22/2021
Status: Open

Cost Sharing for COVID-19 Vaccine and Monoclonal Antibodies Claims

CMS has been made aware of an issue with cost sharing incorrectly applying on Coronavirus (COVID-19) vaccine and monoclonal antibodies claims with condition codes MA and 78 when HCPCS codes 0001A, 0002A, 0011A, 0012A, 0031A, M0239, M0243, M0244, M0245 and M0246 are present on TOB 12X, 13X or 34X. Coinsurance or deductible should not be  applied to these HCPCS codes.

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Open 1626930000000

Jurisdiction 6  and Jurisdiction K Part A providers

Date Reported: 07/28/2021
Status: Open
Part A Home Health Claims Suspending with Reason Codes 39910 and E0419

HH final claims that should take a full reduction (because RAP receipt date is greater than 30 days from the FROM date on the claims) are not populating value codes, but they do have the QF value code. This is causing claims suspensions with Reason Codes 39910 and E0419.

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Open 1627448400000

Jurisdiction K and Jurisdiction 6 Part A HH Providers

Date Reported: 09/03/2021
Status: Open

Home Health Patient-Driven Grouping Model Looping-RC C727D

Home Health (HH) Patient-Driven Groupings Model (PDGM) claims are looping, with Common Working File (CWF) reason code C727D,when the post-acute stay was received in an inpatient rehabilitation unit or a psychiatric unit of a Critical Access Hospital (CAH) having a CCN 3rd frequency M or R. 

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Open 1630645200000

Part A home health providers in Jurisdiction K and Jurisdiction 6

Date Reported: 09/14/2021
Status: Open

Hospice Informational Unsolicited Response Adjustments - Type of Bill 8XG

Due to original informational unsolicited responses (IURs) processing not occurring between the timeframe of 8/1/2017 and 4/1/2021, a significant volume of hospice IUR adjustments have been initiated by the common working file (CWF) to determine if a payment adjustment was necessary. Adjustments may or may not have resulted in payment changes.

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Open 1631595600000

Part A hospice providers in Jurisdiction K and Jurisdiction 6

Date Reported: 09/15/2021
Status: Open

Incorrect Billing for Part A Outpatient Observation Services

The CMS billing instructions for G0378 indicate a single line of coding with a NOS of at least eight, with all UOS on a single line and the DOS being the date of the original observation order. Claim editing changes implemented in July, 2021 are correctly rejecting observation services billed on separate lines. If multiple lines of G0378 are reported on a claim, the claim will now RTP with reason code W7051. All units of service must be reported on a single line to resolve the edit. If you have submitted an appeal request on a claim with inappropriate billing of multiple lines of G0378, any claim adjustment due to the appeal decision will result in the lines being combined. This may cause payment to then be made under a comprehensive APC on a 13X bill type, if units of G0378 are equal to or greater than 8 and you also billed on the same line item date of service or the day before the date reported for observation:

  • A Type A or B emergency department visit (CPT codes 99281 through 99285 or HCPCS codes G0380 through G0384)
  • A clinic visit (HCPCS code G0463); or
  • Critical care (CPT code 99291); or
  • Direct referral for observation care reported (HCPCS code G0379) (must be reported on the same date of service as the date reported for observation services.)

Appeals for these claim denials have resulted in significantly lower payments based on assignment of the comprehensive APC.

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Open 1631682000000

Jurisdiction 6 and Jurisdiction K Part A Providers

Date Reported: 10/19/2021
Status: Open

Reason Code 32307 Error on Investigational Device Exemption Claims

EMC claims containing an IDE service (624 revenue code) are correctly being submitting with only one 2300 REF01 LX REF02 IDE Code, but the system is applying the IDE code to all service lines billed causing reason code 32307 to incorrectly assign.

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Open 1634619600000

Jurisdiction 6 and Jurisdiction K Part A Providers

Date Reported: 10/22/2021
Status: Open

Processing Issue Botulinum Toxin Claims Returned to Provider with 5PRIA

Part A claims that have been submitted with Botulinum J codes (J0585, J0586, J0587, J0588) have incorrectly RTP with reason code 5PRIA.

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Open 1634878800000

Jurisdiction 6 and Jurisdiction K Part A Providers

Date Reported: 11/12/2021
Status: Open

Part B Issue for Coinsurance Payments on Drug Code Claims

Due to an issue with a recent system update, 20% coinsurance for drug codes has been incorrectly calculated during the period of 10/27/2021-11/1/2021.

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Open 1636693200000

Jurisdiction 6 and Jurisdiction K Part B Providers

Date Reported: 11/12/2021
Status: Open

EHR Value Code Q5 Applying to Inpatient Claims

It has been discovered that there is an issue with the IPPS Cloud Pricer that is causing the system to apply value code Q5 and a reduction amount in error. An EHR reduction is calculating on claims not subject to the reduction. The FISS is applying a Q5 value code to claims incorrectly. FISS and CMS are researching the issue.

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Open 1636693200000

Jurisdiction 6 and Jurisdiction K Part A Providers

Date Reported: 01/05/2022
Status: Open

Bill Type 32A Returned to Provider with Reason Code 32114

The Centers for Medicare & Medicaid Services implemented new home health bill type 32A effective 1/1/2022. An issue with ZIP codes submitted on EMC claims has been identified for all Medicare Administrative Contractors, causing it to incorrectly return to provider with reason code 32114.​​​​​​​

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Open 1641358800000

Jurisdiction K and Jurisdiction 6 Part A HH Providers

Date Reported: 07/29/2021
Status: Closed

Temporary Holding for Some Part B Claims

An issue has been identified resulting in the need to hold a segment of claims until the appropriate system fix can be installed.

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Closed 1627534800000

Jurisdiction 6 and Jurisdiction K Part B Providers

Date Reported: 07/29/2021
Status: Closed

Botox Chemodenervation Administration Codes

The above-described administration codes are billed on the Part B claim without the corresponding drug J0585, J0586, J0587 or J0588 and the claim rejects with messages CO16 N56 MA130. The article A52848 indicates the drug should be billed on the same day/same claim; however when the drugs are administered in the hospital outpatient setting, the hospital must bill for the drugs on correlative Part A claim. When the administration services are billed in the outpatient/inpatient setting the Part B claim with the services should be allowed.

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Closed 1627534800000

Jurisdiction 6 and Jurisdiction K Part B Providers

Date Reported: 08/27/2021
Status: Closed
Home Health Core-Based Statistical Area Payment issue (Code 50007)

CBSA Code 50007 was loaded into the CY 2021 wage index table of the home health (HH) Pricer with an incorrect effective date. This error is causing incorrect payment on claims with CBSA 50007 in the Value Code 61 amount field by using the wrong wage index in payment calculation. National Government Services (NGS) has been instructed by the Centers for Medicare & Medicaid Services (CMS) to suspend claims with CBSA Code 50007 and to change it to CBSA Code 28020 which will utilize the correct wage index, allowing for accurate payment for these claims.

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Closed 1630040400000

Part A home health providers in Jurisdiction K and Jurisdiction 6

Date Reported: 10/08/2021
Status: Closed

Part B Remittance Statements Missing Financial Control Numbers

Due to an issue associated with the 10/1/2021 release, Part B remittances classified as withholding (WO) are being generated without FCN information. Without the necessary control number, providers cannot cross-reference the reason for financial offset. 

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Closed 1633669200000

Jurisdiction 6 and Jurisdiction K Part B Providers

Date Reported: 10/15/2021
Status: Closed

Part A 11X Claims Returned to Provider

11X claims with DOS prior to 10/1/2021 with ICD-10 diagnosis code Z515 and POA indicator of Y have RTP with edit message 34931.

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Closed 1634274000000

Jurisdiction 6 and Jurisdiction K Part A Providers