Problems with New G Codes and Service Intensity Add-On Reported

Home Health & Hospice Providers Could Experience Payment Delays

Several of the Medicare Administrative Contractors (MACs) have recently announced system issues with the new G codes that were created last fall to replace G0154. The new G codes went into effect for dates of service on or after January 1, 2016. While their creation was spurred by the need to distinguish between RN and LPN visits for implementation of the Hospice Service-Intensity Add-On (SIA) that went into effect this month, the code changes apply to both hospice and home health:

  • RN – G0299 Direct skilled nursing services of a registered nurse (RN) in the home health or hospice setting
  • LPN – G0300 Direct skilled nursing of a licensed practical nurse (LPN) in the home health or hospice setting

Providers should be aware of system issues and communicate information to billing staff as they may cause payment delays. Some of the issues include:

Hospice:

  • On February 1st, Palmetto GBA announced an issue where Hospice providers were receiving incorrect Service Intensity Add-On (SIA) payments for services that did not qualify for the payment. SIA payment should only be made for the social worker visits and nursing visits provided by a registered nurse (RN), when provided during routine home care in the last seven days of life. The issue has been reported to the Fiscal Intermediary Shared System (FISS) Maintainer and a fix is scheduled to be implemented on February 22, 2016. While no provider action is required at this time, the correction may mean making manual adjustments in your software’s accounts receivable module.
  • Last week, CGS reported a possible Issue with Reason Codes 32402 and 32403. CGS stated in an email notification that they were currently researching a possible issue related to the new G-codes (G0299 and G0300) for reporting direct skilled nursing care visits provided on or after January 1, 2016 and that it impacted both home health and hospice claims that span 2015 and 2016 service dates. CGS stated that some claims were sent to the Return to Provider (RTP) file (status/location T B9997), while others were suspended in status/location (S MFEES). CGS will provide additional information as soon as it becomes available.

Home Health:

  • Last week, Palmetto GBA resolved an issue that they stated was impacting home health claims with episodes that spanned January 1, 2016 that included the new G codes. The new HCPCS codes, G0299 or G0300, are required to be reported for visits made in 2016. On January 25th, Palmetto announced the issue was resolved and that claims that were suspended with reason codes 32402 and/or 32403 had been released for processing. If you had claims return to provider (RTP) for this issue, you may now return (PF9) them for processing.

HEALTHCAREfirst will continue to monitor system issues and post updates as they become available.

February 1, 2016

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