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In anticipation of the April 2017 Release, the CWF Hosts will not process claims beginning Friday, March 31, 2017 through Sunday, April 2, 2017. During this period, which is commonly referred to as “dark days,” the CWF Hosts will install the April 2017 Release, complete weekly/monthly/quarterly processing activities, and perform scheduled data center maintenance. This means Medicare Administrative Contractors (MACs) will not have access to the Health Insurance Master Record (HIMR) and Beneficiary Data Streamlining (BDS) transactions. Eligibility information in HIQA and HIQH will also not be available to providers.

The dark days will not affect your ability to access beneficiary eligibility information through Palmetto GBA’s eServices. In addition, the Interactive Voice Response (IVR) will be available. Palmetto GBA’s PCC will not have access to CWF and cannot assist providers with CWF information, such as beneficiary eligibility and beneficiary verification for claim detail, etc.
Below is a list of scheduled events for the release:

• The CWF Host will implement the Out of Service Area (OSA) drop for March 27, 2017 through March 31, 2017
• The CWF Host will not perform any cross reference files (XREF) March 27, 2017 through March 31, 2017
• The CWF Host will not perform any Health Insurance Correction Record (HICR) transactions from March 27, 2017 through March 31, 2017
• The CWF Host will process normal cycles on March 30, 2017 EXCEPT for the Fraud Prevention System (FPS) – FPS files will be held by the CWF Host and combined/converted (if needed) on April 2, 2017 after the April 2017 Release has been installed
• The CWF Host will execute the final pre-release cycles on Thursday, March 30, 2017. All entities will be receiving CWF response files from the CWF Host Thursday night /Friday morning, March 31, 2017. These final response files must be taken into your final pre-April 2017 release A/B/DME cycles for processing to avoid any release related response file change issues.
• The CWF Host will hold the claims received from MACs on Thursday, March 30, 2017, and Friday, March 31, 2017
• Friday, March 31, 2017, thru Sunday, April 2, 2017, will be ‘Dark’ days for The CWF Host with no onlines available. There will be no access to the HIMR inquiry or BDS transactions
• The CWF Host will start the installation of the CWF April 2017 release on Friday, March 31, 2017, and complete the installation on Sunday, April 2, 2017
• On Sunday, April 2, 2017, the CWF Host will convert (if needed) and combine the SSM satellite claim files held on March 30, 2017 and March 31, 2017 and will send the files to the FPS under the new release for processing
• On Monday, April 3, 2017, the onlines will be available for The CWF Host under the April release. The CWF Host will receive responses from the FPS by the afternoon of April 3, 2017. The FPS response files will be loaded for CWF ISA processing on the night of April 3, 2017. Response files from March 30, 2017 and March 31, 2017 (that are held) will be sent to contractors in the new version for the MAC’s Tuesday, April 4, 2017, night’s processing*.

February 9, 2017

The article below has been updated by Palmetto.  Please check out the update and share with the appropriate staff. Hospice Payment Rates for Routine Home Care (RHC) on and after January 1, 2016

Situation: Effective January 1, 2016, two separate payment rates replaced the single Routine Home Care (RHC) rate: A higher RHC rate for days 1 through 60; and A lower RHC rate for days 61 and beyond. An issue has been identified with the two separate payment rates for RHC services on and after January 1, 2016. On some claims, the high rate is populating on the claim for the RHC days when the low rate should have been applied. Impact to Provider: Overpayments have occurred on certain claims. Status: 2/9/2017: A fix to this issue has been created and is scheduled to be released into production on April 3, 2017. Palmetto GBA is awaiting further direction to correct previously processed claims with incorrect payment amounts. No provider action is required at this time. 12/30/16: Claims for dates of service on or after October 1, 2016, (Hospice FY 2017) are continuing to have the RHC high rate applied in error. This issue is being researched by the FISS Maintainer and Palmetto GBA. We will provide an update as soon as available. No provider action is required at this time. 12/6/16: The fix for this was implemented on December 5, 2016. Palmetto GBA is awaiting further direction to correct previously processed claims with incorrect payment amounts. No provider action is required at this time. 11/23/16: The fix to this issue has been delayed for release into production until December 5, 2016. Palmetto GBA is awaiting further direction to correct previously processed claims with incorrect payment amounts. No provider action is required at this time. 10/21/16: The fix to this issue has been delayed for release until November 21, 2016. Palmetto GBA is awaiting further direction to correct previously processed claims with incorrect payment amounts. No provider action is required at this time. 9/28/16 – A fix to this issue has been created and is scheduled to be released into production on November 7, 2016. Palmetto GBA is awaiting further direction to correct previously processed claims with incorrect payment amounts. No provider action is required at this time.

August 3, 2016

CMS Hospice Update on Incorrect Payments Identified for the Two Tier Payment and SIA Payments

At the July Home Health, Hospice and DME Open Door Forum there was discussion of ongoing claims processing issues related to the new two-tiered payment system for Routine Home Care (RHC) and the Service Intensity Add-on (SIA) for visits at the end of life.  Centers for Medicare & Medicaid Services (CMS) staff identified three issues that are affecting hospice payments for RHC and the SIA, and indicated they would provide written descriptions of the issues for hospice providers and other interested parties.  The following information, containing the known issues and timeframes for correction of these issues, has been extracted from a notice issued by National Government Services (NGS) but is applicable to all hospices.

Two Tier Routine Home Care Payments

Issue: The two tier payment rate is not being applied appropriately to claims submitted on or after January 1, 2016. In some instances the Medicare system is incorrectly paying at a low rate, instead of the high rate. This system action is causing an underpayment to providers. The Medicare system was updated with a “fix” on July 25, 2016 to resolve the issue.

Provider Action: There is no provider action to be taken.

Issue: An issue has been identified with the two tier payment rate not being applied appropriately to claims submitted on or after January 1, 2016. In some instances the Medicare system is incorrectly paying the RHC at a high rate, when the low rate is appropriate. The Medicare system is checking a single prior benefit period and not all benefit periods that are not separated by 60 days. This inappropriate processing is causing an overpayment to providers. CMS is aware of the issue and the MACs anticipate instructions from CMS in the January 2017 release to correct the Medicare system issue.

Provider Action: At this time there is no provider action to be taken. Providers should not report this overpayment on their credit balance reports.

Service Intensity Add-On (SIA) Payment

Issue: In certain situations, the Medicare system is not applying the end-of-life (EOL) service intensity add-on (SIA) payment to the previous month’s claim, when a patient dies within the first few days of a month. The Medicare system is designed to trigger an automatic adjustment of the prior month’s claim if the prior month’s claim is eligible for the SIA payment. This adjustment will apply the EOL SIA amounts to the previous claim that could not be identified in the initial processing. These adjustments are not occurring on the prior months claim in the following situations:

• When the incoming claim does not contain a qualifying RHC service;
• When the provider adjusts the original claim to add qualifying (or additional) RN and/or MSW visits;
• When the provider adjusts the IUR (32G) claim that originally applied the SIA payment, the adjustment claim removes all EOL SIA payments.

CMS is aware of the issue and the MACs anticipate instructions from CMS in the January 2017 release to correct the Medicare system issue.

Provider Action: Currently there is no provider action to be taken. Providers do not need to submit an adjustment claim for the previous month, nor does the provider need to submit an appeal. This is a Medicare system issue.

http://cgsmedicare.com/hhh/pubs/news/2016/0816/cope33630.html