The Center for Medicare/Medicaid Services (CMS) has identified technical issues with certain parts of the April 2013 quarterly update to their computer system and has instructed all Medicare Administrative Contractors (e.g. Palmetto GBA, CIGNA, NGS, Anthem) to hold all EOE (End of Episode) claims with ending dates ‘Through dates’ of April 1, 2013 forward. This mandate will continue until April 14, 2013 when the technical issues should be resolved. Beginning April 15, 2013 all EOE claims that were put on hold will be released for processing.
CMS states the claim hold should have minimal impact on provider cash flow because; clean electronic claims are not paid sooner than 14 days and paper claims are not paid sooner than 29 days after the date the claims were received. CMS also regrets any inconvenience and is working to resolve these issues as quickly as possible.
What this will mean to the home health agency billing staff will be the following: EOE claims can be submitted during this time frame, however, they will not show to be processing on the system and will not have a 277 report come back on these claims. The claims will be held until April 15, 2013 then released to the processing system at this time if all problems with the technical issues have been resolved. No resubmission of these claims should be done during this time frame as this will only cause an increased back log of claims when the system is processing again. Once the issue is resolved and CMS lifts the hold, agency may want to consider re-submitting their claims if claims are not processing. All RAP (Request for Anticipated Payment) claims will be processed during this time and should be submitted as usual.
Just to recap: All EOE(End of Episode) claims have been put on hold for claims ending dates ‘Through Dates’ of April 1, 2013 and forward. This hold will last until April 14, 2013 and beginning on April 15, 2013 these claims will begin processing if the technical issues have been resolved. EOE claims will be allowed to be submitted during the time frame but will be held by the Medicare Administrative Contractor serving your agency and/or State.
Axxess will be monitoring this issue and keep our clients informed with updates.
You may read notices from both Palmetto GDA and NGS on April 2013 Quarterly System Release – Claim Hold below: