Hello, everyone and welcome to our Monday Minute. Today we’re going to discuss the claim issues that still exist with the  U537F edit with the Notice of Admission for Home Health.

This edit had an update in April, 2022, that we were told was going to fix the problem and that indeed has not occurred. The U537F edit is still incorrectly editing NOAs or Notice of Admissions, upon submission some of them are going through, while others are not.  They have reopened on the claims error processing log, the edit for this particular item.  I had a personal discussion with one of the representatives from Palmetto GBA, who said they are working diligently with the programmers to figure out why this edit will just simply not be corrected, but they are working on it.

Also, I want you to keep in mind that for this edit specifically and for many of the others that were holding up the Notice of Admission at the beginning of this process in January, have very specific listings of the wording that you should be using on the exceptions that you’re requesting on the final claim. For example, if the Notice of Admission was late or received date is late, past the five-day window, because of this U537F edit, when you file the final claims that are associated with that Notice of Admission, it being late without requesting an exception using the KX modifier, you would have a processed payment with a penalty. So, in order for you to avoid the penalty, you would need to use the KX modifier on the final claim requesting the exception.  The instructions you have been given is that when you include the remarks on the claim, in the request for that exception, you’re going to specifically state this is a “2022NOA reason code U537F issue”. So, if you use those specific words, the system is going to help expedite the process of your claims being appropriately and timely processed with the exception to the penalty. So, two things, you’re not going to get the penalty, and using the appropriate language will help expedite the processing of that claim with your exception request.

You do need to make sure that any of the Notice of Admissions that you have that have been late, if it truly was a system issue, you are going to need to use that KX modifier and in the remarks section, explain why you’re requesting the exception. Again, if it’s an edit that was the fault of the CMS computer system, you’re definitely going to need to look at the claims error log on your Medicare MAC site and they should give you specific instructions for the language to use in the remarks section, as I’ve given you today for this U537F issue.

We want to thank you all for participating today. Do make sure that regardless of which of the three Medicare MACs is your Medicare MAC, you stay in contact with them, meaning you are signed up to receive their email updates and their notifications of things that are going on within your Medicare MAC. You can also sign up for webinars and ongoing education that each of them provide. Make sure that you’re checking out those claims error logs that are found in the claims section for both Home Health and Hospice so you can keep up to date with the issues that they have identified and the point that they are in the process of resolution.

Thank you all for participating today and as always, we hope to see you at a live conference soon. Have a fabulous week.