A May 4 post on Medicare Administrative Contractor (MAC) Palmetto GBA’s website indicates that an issue involving overpayments for certain hospice claims now won’t be resolved until January 2017, rather than in July 2016.
 
Palmetto says the issue was identified for hospice services provided on and after Jan. 1, 2016. On some claims, the high rate (for days one through 60) is populating on the claim when the low rate (days 61 and beyond) should have been applied.
 
The extent of the issue has not been determined, a Palmetto spokeswoman tells HHL.
 
“What we know is that it is related to claims where the patient has multiple elections during the lookback period for the hospice routine home care rate calculation,” she says. “The intent of the policy is to look at all the prior benefit periods that are not separated by a 60-day gap, but the system is only going back to the prior period.”
 
It’s possible the system change will move up on the schedule “once the root cause — the extent of the changes — is fully understood,” she says. Visit http://bit.ly/1WON1yJ or call (855) 696-0705 to stay updated on the issue.