Am I correct in that you are billing PDGM final claims for skilled nurse visits? Or are you billing visits with the HIPPS code.
Tracy Salin
Billing Specialist
Fairview Range Home Care and Hospice
Phone: 218-262-6982
Fax: 218-262-1723
From: billers@list.mnhomecare.org <billers@list.mnhomecare.org>
On Behalf Of Jessica Demarais
Sent: Wednesday, July 29, 2020 12:41 PM
To: billers@list.mnhomecare.org
Subject: RE: Question from a member
Crisa- unfortunately our claims are still in pending status, so I’m not sure if we too will receive denials for the bill type 332. This is the message we received when the clearing house closed the ticket with a solution:
(Waystar)
Hello Jessica,
I have called and left you a voicemail. I have heard back from the Payer/Intermediary regarding this case.
· What was the issue? The claim rejected in the system.
· Why did this happen? Per the rep and ref# 04282020332755
“These are the bill types we have for HHA on the front end: 322, 327, 328, 329, 332, 337, 338, 339, 32Q, and 33Q. Anything else will try to verify the HIPPS as a HCPCS code and will
cause the rejection.
CLM*18611*382.51***32:A:3**A*Y*Y~
The CLM05-1 is '32' but the CLM05-3 is a '3' so the bill type is 323 and that is what is causing the claim to reject.”
· What steps were taken to fix it? Provider will need to change the bill type and resubmit the claim.
If you need clarification on the resolution or instructions, feel free to call me at 502-882-4775 I am in the office from 8:30 am-4:30 pm (ET). If you feel the case needs to be reopened,
you may do so within 3 days through the Support and Training Center or by calling Client Support .
Thanks!
Comment (0)July
21, 2020 at 8:44 AM
From: billers@list.mnhomecare.org <billers@list.mnhomecare.org>
On Behalf Of Mortenson,Crisa
Sent: Wednesday, July 29, 2020 12:18 PM
To: billers@list.mnhomecare.org
Subject: RE: Question from a member
Jessica – I’m currently dealing with denials for invalid bill type and POS for homemaker services from Optum VA. Did you get paid on the 332 bill type?
Also – is anyone using Nightingale Notes for Home Health that can tell me the claim template you’re using for non-skilled Optum VA?
|
|
Crisa Mortenson Billing Officer Phone: 218-843-3852 Fax : 218-843-2311 Email:
crisa.mortenson@khmc.net
1010 S Birch Ave. P.O. Box 700 Hallock, MN 56728 |
From: billers@list.mnhomecare.org <billers@list.mnhomecare.org>
On Behalf Of Jessica Demarais
Sent: Friday, July 24, 2020 11:36 AM
To: billers@list.mnhomecare.org
Subject: [EXTERNAL] RE: Question from a member
Skilled nursing, whether it’s bundled with other services (PT OT), or non bundled, we are billing per CMS guidelines. HHA and HMK we are billing FFS with no Hipps code, and the type of bill 332 per Optum guidance. Not entirely sure if
payment is driven by Oasis since we haven’t received payment yet, but based on the guidance we have received, they will be processing by line item, but still require Hipps code, etc.
Unfortunately things are not entirely clear with Optum VA, but I hope this helps a little!
From: billers@list.mnhomecare.org <billers@list.mnhomecare.org>
On Behalf Of Tuma, Darlene
Sent: Friday, July 24, 2020 11:19 AM
To: 'billers@list.mnhomecare.org' <billers@list.mnhomecare.org>
Subject: RE: Question from a member
Why skilled nursing both ways? And OASIS? Is payment driven by OASIS like Triwest?
Darlene Tuma, RN, PHN
Adult Health Supervisor
Le Sueur County Public Health
88 South Park Ave
Le Center, MN 56057
507-357-8249
Fax: 507-357-4223
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From: billers@list.mnhomecare.org <billers@list.mnhomecare.org>
On Behalf Of Jessica Demarais
Sent: Friday, July 24, 2020 11:12 AM
To: billers@list.mnhomecare.org
Subject: RE: Question from a member
We are billing skilled services, bundled and non bundled per CMS guidelines, but only submitting final claims. For HHA HMK services, we are billing FFS, and the type of bill required for those claims is 332. All other bill types will
be rejected. We had a ticket open for almost 3 months, and it has just been resolved in the last week, so we have finally gotten our claims through the clearinghouse and to Optum for processing. No claims have processed for payment yet, however, so we’re
not 100% sure this is the correct guidance!
From: billers@list.mnhomecare.org <billers@list.mnhomecare.org>
On Behalf Of Karen Peterson
Sent: Friday, July 24, 2020 10:43 AM
To: billers@list.mnhomecare.org
Subject: Question from a member
All,
I received this and hope you can respond! I’ll pass on your words of wisdom:
Most auths from VA are now Optum. I am having a hard time finding out if Optum requires OASIS. They state they follow medicare guidelines but yet services are fee
for service / non-bundled unless therapy is involved. Optum can't even tell me. After the trouble with Tri-west I want to stay on top of this
Thanks,
Karen Peterson
Regulatory Affairs and Advocacy Manager
Minnesota HomeCare Association
2550 University Ave. W., Ste. 350 S | St. Paul, MN 55114-1900
Direct: 651.659.1457 | Main: 651.635.0607
Toll-free: 866.607.0607 | Fax: 651.635.0043
Mission:
MHCA represents and supports Minnesota home care providers committed to high quality home care services.
Vision:
MHCA will shape the home care landscape to improve and sustain quality home care services.
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