Hello,

There was a time we were receiving the expected payments from Humana. Long long ago

In 2020 under PDGM they began largely overpaying accounts due to changing the Timing of the HIPPS code incorrectly.

We would bill a Late episode and they would pay the claim as an Early episode even though there was less than a 60 day gap between the last episode service date and next episode service date.

Now in 2021 with the No Pay RAP – we are billing the No Pay RAP within the 5 days to avoid a penalty with a VALID Generic HIPPS code on the No Pay RAP and matching HIPPS on the Final claim.

Humana seems to be using the OASIS to determine payment for the 30 day episode but they are paying the Function Level as LOW (A) on all of the claims.  We are underpaid when the Function Level score was determined to be Medium (B) or High (C) at the SOC Assessment.  I have called and submitted inquires to the Correspondence – they respond with a generic response they paid the claim correctly – never addressing the are changing/paying all claims as a LOW (A) Function level.

Is anyone else experiencing the underpayments/incorrect payment due to incorrect Timing and or Function level paid by Humana? Any resolution?

Thank you

CAUTION: This email originated from outside of the Allina Health network. Do not click links or open attachments unless you recognize the sender and know the content is safe.

Thank goodness we don’t have a contract because they don’t pay. If they do pay, they take it back, You can’t get any help when you call, They don’t understand what billers are saying, Also payment history was never consistent. It’s been aweful since my last billing job 13 years ago. The only thing they get well is the eligibility and benefits info.

Hi all!

The Payer Liaison group is planning to meet with Humana during our next meeting. In the meantime, we are looking for constructive feedback to better guide our conversation. If you have a contract with Humana, we would love to hear from you on what you feel they do best and what areas you find challenging.

Please remember MHCA complies with antitrust laws and therefore want to ensure that competitively sensitive information is not shared in this email chain. Please do not reply all through this email thread. Reponses should only be sent to Jaime Kummer, Payer Liaison Chair at jkummer@rvhci.com

We look forward to hearing from you!

Jaime Kummer | Administrator | River Valley Home Care Inc.

916 8th Street Farmington, MN 55024

Phone: 651-460-4201

Email: jkummer@rvhci.com