That’s how we are billing as well, Marnie, but in the beginning of the year, we didn’t know this plan was requiring HIPPS, so essentially claims went out fee for service. When the claims starting denying, initially they just said we needed
the Occ code 50, so we’d resubmit with Occ code 50, then the claim would deny for no Rev code 0023. So they’re essentially saying we need to be billing PDGM for the Adv Solution Plan, but neglected to properly address this, or prepare for the processing of
these claims themselves. Their billing system wasn’t set up appropriately for PDGM, and beginning of October, they must have had a system update which generated an update from CMS regarding PDGM, so the only then realized that is how this plan should have
been billed since Jan 1 2021. Well since we didn’t have our payor set up that way, our claims did not generate a HIPPS code from Jan 1- approximately April, so we had to manually add a line for Rev code 0023 to existing claims. Those claims then finally
paid once we added the line with Rev code 0023, but now those claims are being taken back because there is no HIPPS code along with the Rev code 0023. We have not had any take backs on claims that were billed completely under the PDGM model, starting around
April-May.
It has been a complete nightmare to say the least, and only with the Adv Solution Plan.
From: billers@list.mnhomecare.org <billers@list.mnhomecare.org>
On Behalf Of Marnie Pogreba
Sent: Wednesday, October 13, 2021 12:07 PM
To: billers@list.mnhomecare.org
Subject: RE: EXTERNALMedica Adv Solution plan
We bill per visit too, but they have wanted us to put the HIPPS code on the claim, even though they do not pay by the HIPPS code. Now, I am a little worried about take backs.
Marnie
Lakewood Health System Home Care & Hospice
218 894 8324
From: billers@list.mnhomecare.org <billers@list.mnhomecare.org>
On Behalf Of Karen Gorecki
Sent: Wednesday, October 13, 2021 11:22 AM
To: billers@list.mnhomecare.org
Subject: RE: EXTERNALMedica Adv Solution plan
|
**External Sender**
|
Did you bill per visit or per episode?
We are billing per visit. First in 2021 paid correctly. Now last few ones have paid less saying we are not in network but we are in network. Say it is a recertification issue that we haven’t been able to figure out yet.
Karen
From: billers@list.mnhomecare.org <billers@list.mnhomecare.org>
Sent: Wednesday, October 13, 2021 11:18 AM
To: billers@list.mnhomecare.org
Subject: EXTERNALMedica Adv Solution plan
CAUTION: This email originated from outside of the organization. Do not click links or open attachments unless you recognize the sender and know the content is safe.
Good morning-
Is anyone getting take backs from Medica on the Adv Solution Plan (MEDM1)?? And what are you doing to resolve this?? After almost an entire year fighting with Medica on how they want us to bill this plan, now they are taking back payments
because there were no RAPS!!! And they JUST FINALLY started paying the claims in about June, and now they are taking everything back. First, they denied because they wanted the Occ code 50. Then they denied for no REV Code 0023. Now they’re taking back
all payments, and denying all new claims with no RAP. I’m at a loss with them!
Feedback appreciated!
Thank you!
Be Compassionate. Be Accountable. Be Respectful. Be Excellent!
Jessica DeMarais
Claims Specialist
Guardian Angels Elim Home Care and Hospice
403 Main Street, Elk River, MN 55330
Direct 763-452-4163
Main 763-241-0654
Fax 763-241-0274
Email
jdemarais@gaehc.org
Guardian Angels † Elim Home Care & Hospice is jointly owned by
Guardian Angels
Senior Services and Cassia, an Augustana/Elim affiliation.
CONFIDENTIALITY NOTICE: This message (including any attachments) may contain confidential client information. The information is intended only for the use of the individual or entity
to whom it is addressed. If you're not the addressee or the employee or agent responsible to deliver this e-mail to its intended recipient, you are hereby notified that any review, use, dissemination, distribution, disclosure, copying or taking of any action
in reliance on the contents of this information is strictly prohibited. If you have received this communication in error, please notify the sender immediately, delete this message from your computer and ask your network administrator to delete it from any
storage or back up files.
This email and any files transmitted with it are confidential and intended solely for the use of the individual or entity to whom they are addressed. If you have received this email in error please notify the system manager.
This message contains confidential information and is intended only for the individual named. If you are not the named addressee you should not disseminate, distribute or copy this e-mail. Please notify the sender immediately by e-mail if you have received
this e-mail by mistake and delete this e-mail from your system. If you are not the intended recipient you are notified that disclosing, copying, distributing or taking any action in reliance on the contents of this information is strictly prohibited.