CMS expects to know a final date for the long-awaited outlier fix within days.

The federal Medicare agency shared this and other updates during the July 11 open-door forum.

Meanwhile, CMS has assigned the highest priority to the outlier problem and is getting daily updates on a fix for the software glitch that's been causing overpayments and underpayments to agencies since 2010, said Wil Gehne of the provider billing group.

Once the fix is in place, the Medicare administrative contractors (MACs) will immediately begin adjusting claims and issuing payments to those agencies that were underpaid. This will take priority over addressing any overpayments, he noted.

CMS also responded to several provider questions during the call:

  • When a patient has a late face-to-face encounter and at the reset start of care date the only remaining service is occupational therapy, the patient doesn't meet home health coverage requirements anymore, said Randy Throndset, acting director of the home health, hospice and HCPCS division. That's because occupational therapy cannot be a qualifying service for an initial episode, according to Medicare coverage regulations.
  • A Home Health Advance Beneficiary Notice (HHABN) option box 3 must be issued when a supplemental order from a physician establishes an increase and subsequent decrease in frequency.
  • An HHABN option box 3 also must be issued when a skilled service is temporarily put on hold.

Finally, CMS has posted the following educational materials: