Hello everyone, and welcome to our Monday Minute. We’ve not had an update or given you an update in the last couple of weeks on the Notice of Admission Implementation for Home Health and today I have some pretty frustrating news to share with you regarding that Notice of Admission and the full implementation process.

In a meeting with Palmetto GBA in the last couple of days, we have had confirmed by them, which I’m sure applies to both NGS and CGS as well, they have confirmed that you will be required to use the KX modifier on your final claims and request an exception to late Notice of Admissions, even in the situation where the problem that caused your Notice of Admission to be late was a Medicare MAC claims processing error.

The most frustrating part of this is the implementation time that the MACs have had. They weren’t fully prepared, at least the systems weren’t fully updated. They (MAC Systems) caused these situations and now the agency is going to have to bear the burden of not only spending their time to get the exception appropriately reflected on final claims, but you’re also going to have a delay in payment because they will have to go through manual processing of the exceptions request to ensure that the exceptions are appropriate.  Having said that, you do want to make sure that your staff that will be responsible and for filing the exceptions on those final claims have reviewed the claims processing logs on your Medicare MAC’s site.

In Palmetto, specifically, I can confirm that with a couple of these errors, that started early on in January, they have provided some specific instruction as to what needs to take place on the final claims in order to expedite the processing of those claims and get a full payment without having a late penalty. It involves a specific code that needs to be put in the remarks section. Make sure that you get the right people in front of those logs to ensure that the details are used in the filing of your final claims. We will provide the link to those three Medicare MAC websites, specifically to the logs, if we can go links all the way to the logs of those websites, in this Minute.

We want to thank you for participating today. I’m very sorry that I did not have better news for you, but the reality is, we’re talking about Medicare here, right? And it can be a very frustrating process. So thank you again, for participating. Make sure you stay tuned to your state and national Home Care and Hospice associations, and I truly hope to see you very soon at a live event near you. Have a fabulous week.


Jurisdiction M HHH – Claims Payment Issues Log (