Medicare administrative contractor CGS recently outlined an ongoing issue related to home health final claims and adjustments within the Fiscal Intermediary Standard System (FISS), as well as the resolution of two issues that had been leading to incorrect denials or claims rejections.
 
As of May 22, some home health final claims and adjustments were being suspended in status/location S M90H4 with reason code E0419, CGS reported on its website. The issue was that the Common Working File (CWF), for some home health final claims and adjustments, was not providing information in order for the FISS to apply the appropriate value code(s) 62-65, which indicated if payment should be made from the Part A trust fund, Part B trust fund or both, CGS said.
 
CMS expects a resolution to the issue by the end of July.
 
Resubmit claims denied in error
 
CMS is asking agencies to resubmit claims that have been denied in error related to reason codes 37236, 37237 and 32072, according to guidance provided to CGS on July 13. Note that the untimely filing edit also will be bypassed.
 
However, if the claim was denied (D B997 status/location), you have to follow the “Ordering/referring denial reopening” process, CGS reports. Moreover, you can’t resubmit your claim.
 
The issue had caused more than 1,300 home health claims and adjustments to possibly be denied improperly, CMS has said. Some of the claims or adjustments had been submitted with ordering- or referring-physician information that matches the Medicare Ordering and Referring File on the CMS website; however, FISS was indicating the physician’s information is not on the PECOS file. Or, FISS was indicating there is more than one physician record on the PECOS file, but one of the records shows a termination date.
 
Separately, providers could, as of June 22, resubmit claims that were rejected incorrectly related to reason code U5220 and U5210, CGS announced. Claims submitted for beneficiaries who are entitled to either Medicare Part A or Part B were incorrectly rejecting, but the issue has been resolved, CMS says.