Change Healthcare Cybersecurity Breach

On February 21, 2024, Change Healthcare experienced a major network interruption caused by a cybersecurity attack. This attack caused service disruption to pharmacies, payers and providers nationwide. Many payers and clearinghouses have now established alternative EDI connections so providers can continue doing business. Providers should check for rejected claims and reach out to the payer for information on alternative connections to resubmit their claims. The latest information regarding this breach can be found here. 

2024 Physician Fee Schedule Change

On March 9, 2024, the Consolidated Appropriations Act of 2024 was passed, which included a 2.93% update to the CY 2024 Physician Fee Schedule (PFS) Conversion Factor (CF) for dates of service March 9, 2024, through December 31, 2024. Your systems should be updated with this current information to ensure proper accounts receivable balances for Medicare. If you have questions regarding this change, please reach out to Gina Alifano or Lacy Albright.  

Home Health and Hospice Billing

We are adding a new section to our quarterly newsletter: Home Health and Hospice Billing. The Medical Billing Department at RKL has a dedicated team specializing in these unique types of billing. Each quarter, we will highlight information and import updates. Anyone wanting to know more about this billing and the services we offer may contact Lacy Albright. 

Return to Provider Reason Code 19963, Notice of Admission Not Found

• On August 1, 2023, Medicare initially reported on its Claims Processing Issues Log that some claims were identified as Returned to Provider (RTP) in error for Reason Code 19963 because the corresponding Home Health Notices of Admission (NOA) is offline. Medicare Administrative Contractor (MAC), CGS status action was updated on February 22, 2024, notifying providers it was unable to restore/process all affected NOAs/claims. At that time, CGS informed providers that to see the Claims Processing Issues Log Provider Action, providers had to fax a list of NOAs/claims identified that were RTP’d in error for this reason code. CGS requested a fax with the list of claims identified be faxed directly to its Claims Department at 615-660-5982 to be reprocessed. Providers with NOA’s that are still unresolved due to this Reason Code need to fax the information to the number listed above. A Late NOA Exception Request may also be required in order for claims to be processed. More information on this open claims processing issue and others can be found here.

New Online J15 DDE PPTN Application/Reactivation Form

• Effective Tuesday, February 27, 2024, CGS released a new online version of the J15 DDE PPTN Application/Reactivation Form. This online form provides users with a more accurate and efficient process for submitting DDE PPTN access requests. As of March 27, 2024, paper forms are no longer being processed, and any received after this date will be rejected. Additional information on this new online form can be found here.

PCC Corner

Medicare B Deductible Transfers:

It is not recommended to set up the Medicare B deductible within a resident payer tree. If the deductible is set up, PCC will apply the deductible to charges until the dollar value has been met. In most cases, a facility will not be assessed the full deductible since other providers may be assessed a portion of the deductible. The best practice is to make an adjustment to move the deductible to the appropriate next payer.

When Medicare pays a claim and assesses a portion of the deductible to the resident, an adjustment will need to be made to move the deductible from Medicare B to the next payer for the resident (Insurance, Medicaid or private pay). This is an example of moving a deductible to Medicare B coinsurance from Medicaid payer.

Since the Medicare deductible is not entered into PCC, when Medicare calculates the deductible's application, there will be a remaining balance in the Medicare B payer that needs to be contracted off. Due to calculation differences between PCC and Medicare, the remaining amount should be roughly 2% of the deductible amount. The deductible amount will be reflected on the Medicare remit with reason code 1.

The best practice is to review the Medicare remit for Reason Code 1 and enter and post the adjustments at the same time as the remit posting.

Any providers with PCC questions may contact Paula Hynum. 

Questions about these updates? Need support to meet requirements?

Contact Stefanie Knaub, RKL Senior Living Services Partner, at 717.590.8648.