The majority of my claims aren’t paying the $ that billing software calculating. Also if enter info on calculator it comes up with 3^rd different $....

From: billers@list.mnhomecare.org <billers@list.mnhomecare.org> On Behalf Of Vig,Terisa
Sent: Tuesday, March 29, 2022 1:36 PM
To: billers@list.mnhomecare.org
Subject: EXTERNALRe: NOA, Medicare denial

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Haven't had that happen yet but today I got a final claim paid at 1/4 of what we expected. 2^nd 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

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