A recent edit is blocking home health and hospice claims from being paid at Palmetto GBA, and possibly at NGS and CGS as well.
The edit, which begins with the number “5” and the letter “Z”, is not only stopping payment but is also changing the bill type to a 320 for home health. Many agencies across the nation have identified that these claims are not being paid.
Palmetto GBA has been notified of the issue. At the end of last week, they included this information on their claims billing issues log stating that the issue is under investigation and that they are determining what actions need to be taken to ensure claims are getting processed and paid. There is no further action that needs to be taken by home health or hospice agencies.
The importance of having a connection within your organization to your Medicare MAC (Medicare Administrative Contractor), whether it’s Palmetto GBA, NGS or CGS, is crucial so your agency stays informed when issues like this arise. Daily emails, monthly newsletters, ongoing webinars, and educational sessions are available from these organizations. Connecting with your Medicare MAC will ensure your agency stays informed about evolving changes, edits, policies and regulations, and potential updates that could impact future billing.
In the context of billing and collections within the Medicare system, it’s crucial to check daily on claims transmitted the previous day to confirm that the claims were accepted and are processing. Additionally, monitor any denied or rejected claims to ensure proper and timely payment.
Healthcare Provider Solutions promptly reported this issue to Palmetto GBA due to the processes we uphold in billing and collections for our Medicare billing clients. To learn more about HPS Hospice or Home Care Billing and Collection services, or if you need more information about the edit that is causing Palmetto to reject and not pay claims, please feel free to reach out to us.
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