Haven't had that happen yet but today I got a final claim paid at 1/4 of what we expected.  2nd 30 day claim, not a LUPA and the final oasis sent and accepted prior to submitting claim.  The only odd thing  is Medicare changed the HCPCS to NNNNN.  Explanation is code 97 which makes no sense.

I called NGS and they elevated it to a Tier 2 which will re-run it through the pricer.  Now I wait to hear their explanation. 

Just wondering if anyone else is seeing this?

Terisa Vig
Patient Account Representative
RiverView Health Home Care
tvig@riverviewhealth.org
218-281-9240
From: billers@list.mnhomecare.org <billers@list.mnhomecare.org> on behalf of Marnie Pogreba <marniepogreba@lakewoodhealthsystem.com>
Sent: Tuesday, March 29, 2022 1:27 PM
To: billers@list.mnhomecare.org <billers@list.mnhomecare.org>
Subject: [EXTERNAL] NOA, Medicare denial
 

Hello,

 

Has anyone had their NOA deny with reason code: U537F ?  I see this is a known system issue with Medicare, when the CWF does not recognize the discharge status from the last home care stay.  I am wondering if anyone knows of a work around for this issue?  Maybe this was addressed in a past email, I apologize if I am repeating something.  There is no direction on NGS, they just say the proposed resolution/fix is TBD.

 

If you found something that worked for you, please share.

 

Thank you,

 

Marnie

Lakewood Health System Home Care & Hospice

Phone: 218 894 8324

Email: marniepogreba@lakewoodhealthsystem.com

 

 



This message (including any attachments) may contain confidential information. The information is intended only for the use of the individual or entity to which it is addressed. If you are 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 us immediately by return email and destroy all copies of this communication, including all attachments.
-----------------------------------------------------------------------
Confidentiality Notice: This e-mail message, including any attachments,
is for the sole use of the intended recipient(s) and may contain
privileged and confidential information.  Any unauthorized review, use,
disclosure or distribution is prohibited.  If you are not the intended
recipient, please contact the sender by reply e-mail and destroy
all copies of the original message.