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Correcting Home Health Information Posted to the Common Working File (CWF)

There are times when home health episodes/periods of care are truncated (shortened) due to the submission of two Requests for Anticipated Payment (RAPs) where the "FROM" dates are less than 60/30 calendar days apart. When this occurs, billing errors can arise because the dates of service submitted on the final claim may not fall within the beneficiary's episode/period of care history posted to the Common Working File (CWF). Reason codes 79079 and U5386 may both be assigned to the home health final claim when this occurs.

  • If claims are located in FISS status/location (S/LOC) T B9997 with reason code 79079, please review the remarks on FISS Page 04 for additional instructions.

Correcting this issue requires that all the incorrect episode/period of care information be removed from the CWF. This means that all RAPs/claims that are contributing to the error must be cancelled. If the RAPs that created the incorrect episode/period of care have auto-cancelled, you will need to re-bill them and allow them to process (P B9997) prior to submitting the cancel RAPs. Instructions for canceling RAPs using the Fiscal Intermediary Standard System (FISS) are available in "Chapter Five: Claims CorrectionPDF" of the FISS Guide.

  • Review the beneficiary's home health episode/period of care information to determine which episode(s)/period of care need to be cancelled. See the CGS Checking Beneficiary Eligibility Web page for more information about the systems available to providers to check Medicare beneficiary eligibility information.
  • Allow the canceled billing transactions to finalize and submit the episode/period of care information correctly

Scenario

Under the home health Prospective Payment System (HH PPS): Two RAPS are submitted for the same beneficiary. The first RAP has a "FROM" date of 04/26/YY and the second has a "FROM" date of 05/02/YY. The home health final claim is submitted with dates of service 04/26/YY - 06/24/YY. However, the final claim cannot process due to the 05/02/YY- 06/30/YY episode that was established at CWF. In addition, both RAPs have auto-cancelled.

Under the home health Patient-Driven Groupings Model (PDGM): Two RAPS are submitted for the same beneficiary. The first RAP has a "FROM" date of 04/26/YY and the second has a "FROM" date of 05/02/YY. The home health final claim is submitted with dates of service 04/26/YY - 05/25/YY. However, the final claim cannot process due to the 05/02/YY- 05/31/YY period of care that was established at CWF. In addition, both RAPs have auto-cancelled. For additional information regarding how to use FISS to determine if RAPs have auto-canceled, see the instructions — "Checking for Auto-Cancelled Requests for Anticipated Payment (RAPs)" found in Chapter Three: Inquiry MenuPDF of the FISS Guide.


For additional information regarding how to use FISS to determine if RAPs have auto-canceled, see the instructions — "Checking for Auto-Cancelled Requests for Anticipated Payment (RAPs)" found in Chapter Three: Inquiry MenuPDF of the FISS Guide.

Steps to Correct

To correct this error under HH PPS, the HHA will need to:

  • Re-bill the 05/02/YY RAP.
  • Once it finalizes, a "cancel" RAP must be submitted for the 05/02/YY episode.
  • Once the 05/02/YY "cancel" RAP finalizes, the 05/02/YY - 06/30/YY episode will be removed from CWF.
  • Re-bill the 04/26/YY RAP.
  • Once the 04/26/YY RAP finalizes, submit a "cancel" RAP in order to remove the 04/26/YY - 06/24/YY episode from CWF.
  • Once this "cancel" RAP finalizes, the HHA can then re-bill the RAP to establish the episode for the correct dates of service — 04/26/YY - 06/24/YY.
  • Once the corrected RAP finalizes, either re-submit the final claim or F9 the claim from T B9997.

To correct this error under PDGM, the HHA will need to:

  • Re-bill the 05/02/YY RAP.
  • Once it finalizes, a "cancel" RAP must be submitted for the 05/02/YY period of care.
  • Once the 05/02/YY "cancel" RAP finalizes, the 05/02/YY - 05/31/YY period of care will be removed from CWF.
  • Re-bill the 04/26/YY RAP.
  • Once the 04/26/YY RAP finalizes, submit a "cancel" RAP in order to remove the 04/26/YY - 05/25/YY period of care from CWF.
  • Once this "cancel" RAP finalizes, the HHA can then re-bill the RAP to establish the period of care for the correct dates of service — 04/26/YY - 05/25/YY.
  • Once the corrected RAP finalizes, either re-submit the final claim or F9 the claim from T B9997.

Updated: 01.22.20

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