CMS and its contractors are working with the Fiscal Intermediary Standard System (FISS) to resolve an issue that is causing more than 1,000 home health claims and adjustments to have possibly been denied improperly.
 
The issue is specifically related to reason codes 37236 and 37237; to date, there are 1,294 denials related to reason code 37236 and 77 denials related to 37237, says Carolina Fortin-Garcia, with the CMS Media Relations Group.
 
Some of the home health claims and adjustments are being submitted with the ordering/referring physician information that matches the Medicare Ordering and Referring File on the CMS website. However, the provider file in the FISS indicates the physician’s information is not on the Provider Enrollment Chain and Ownership System (PECOS) file, Fortin-Garcia says.
 
A timetable for resolution has not yet been identified.