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Fiscal Intermediary Standard System Claims Processing Issues

Updated: 06.08.17

Listed below are current system-related claims processing issues that have been reported to the Centers for Medicare & Medicaid Services (CMS) and/or the Fiscal Intermediary Standard System (FISS) Maintainer. This information is updated as we receive new information or updates to share. Please check this Web page for updates before calling the Provider Contact Center, and watch for Listserv messages announcing updates to this page.

Provider Types Affected Reason Code Issue Impact Status Resolved
Home Health and Hospice E94G2 2/21/2017 – Some home health and hospice claims are suspending with reason code E94G2 in status/location S M90PP. FISS is incorrectly applying the reject reason code 32352 and changing the type of bill from 329 to 320. 2/21/2017 – Home health and hospice claims affected by this issue are suspending in status/location S M90PP with reason code E94G2. 2/21/2017 – (Updated 03/28/2017) The CGS Technical team is researching this issue. CGS Claims staff are manually working the claims to continue processing. Please note, according to the Medicare Claims Processing Manual (Pub. 100-04, Ch. 1, §80.2.1.1External PDF) Medicare contractors have 30 days to process clean claims.  In the event that claims cannot be processed within 30 days, claims will be paid with interest. 5/30/2017 – The research done by the CGS Technical team indicated that the E94G2 is not a system issue.  Appropriate No-Pay codes will be applied as necessary and the claims will be recycled to continue processing.  No action by providers is necessary.
Hospice NA 7/15/16 Update:
5/6/16 – An issue has been identified with the 60 day 'high' and 'low' Routine Home Care rate being applied incorrectly.
7/15/16 Update:
5/6/16 – Some hospice claims with dates of service on and after January 1, 2016, are having the high RHC rate applied when the low rate should have been applied, and vice versa.
05/30/17 – Medicare has corrected most of the system errors associated with 2016 hospice service intensity add-on and RHC payments; however, two issues still remain, which require Hospices to submit adjustments.  Refer to the MLN Matters Special Edition article SE17014External PDF for additional information.

09/28/16 – In the August 18, 2016, Provider eNewsExternal PDF CMS notified hospices that Medicare Administrative Contractors (MACs) would adjust claims to correct miscounting of routine home care days. Due to incorrect payments, MACs will stop adjustments until a solution is implemented.

09/16/16 – Refer to the following articles for additional information:
5/6/16 – The Centers for Medicare & Medicaid Services (CMS) is aware of, and is researching this issue.
 
Home Health E0419, V8029, V8030, V8031, and E46#V 1/17/2017 – Some home health claims and adjustments are cycling in FISS with reason codes E0419, V8029, V8030, and V8031.

03/02/16 – The issue involving some adjustments (type of bill XXG), continues as previously reported. Refer to the "Resolved Fiscal Intermediary Standard System (FISS) Issues" web page for details.
03/02/16 – Some home health claims and adjustments (type of bill XXG) are suspending in status/location S M90H4 with reason code E0419, V8029, V8030, and V8031. 5/30/17 (Updated 06/09/2017) – At this time, adjustments (TOB XXG) continue to suspend in status/location S M90H4 and S M90H1. Additional issues related to the value codes were discovered.  FISS maintainers have scheduled a resolution for implementation on July 3, 2017.  Please note that this resolution does not address final claims.

12/01/16 – A resolution to this issue has been scheduled for implementation in April 2017. Claims and adjustments affected by this issue will suspend in status/location S M90H4 with reason code E0419, V8029, V8030, and V8031.

5/6/16 – The April 25, 2016 system implementation failed to fully resolve this issue. The system maintainer has been informed. As mentioned below, CGS will continue to manually work through the suspended adjustments.

3/2/16 – A resolution to this issue is scheduled for implementation on April 25, 2016. Until a resolution is implemented, CGS will manually work through the suspended adjustments. Please note that due to the manual process and other limitations, some may not process until the scheduled implementation.
 

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