1. Medicare Home Health Billing Updates from CGS PHA Annual Conference – State College, PA May 17, 2012

2. CGS Home Health Claims Data Number of Home Health “Claims” Submitted 1,052,833 Total of Top 6 HH “Claims” Billing Error Reasons 83,455 (7.93%) 2 November 1, 2011 – March 31, 2012

3. Top Home Health Billing Errors Referred to as Claim Submission Errors (CSEs) Results in RAPs/claims being rejected (R BXXXX) or returned to provider (RTPd) (T B9997) Assigned 5-digit reason code which defines error Impact of CSEs » Creates additional work for billers » Costs agencies $$ » Delays payment for services provided 3

4. 4 Top CGS Home Health Billing Errors Reason Code Error Caused By# of Errors 38107FISS can’t find matching RAP44,372 38157/ 38200 Duplicate billing – same beneficiary/same dates of service/same billing provider 20,752 U538IOverlap another HHA’s episode8,247 31755HIPPS code/LIDOS mismatch5,404 31147 HIPPS code/supply billing mismatch 4,680 November 1, 2011 – March 31, 2012

5. ‘Top Claim Submission Errors (Reason Codes) and How to Resolve’ web page, www.cgsmedicare.com/hhh/education/materials/CSEs. html » Lists most common errors by RC » Explains reason for error » Provides suggestions for how to prevent/resolve 5 Top Home Health Billing Errors

6. Top HH+H Provider Inquiries Number of Home Health/Hospice Provider Telephone Questions Handled 19,921 Sum of Top 5 Home Health/Hospice Inquiry Reasons 8,658 Percent of Total Inquiries43.46% 6 November 1, 2011 – March 31, 2012

7. 7 Inquiry Triage Process Source of Information: CMS Pub. 100-09, Ch. 6, § 30.1

8. 8 Reason for Call Type of Issues# of Calls Billing Instructions Instructions for submitting MSP claims, special billing situations, new billers 2,507 Provider Enrollment Requirements Provider enrollment revalidation2,208 Claim Correction Understanding reason code narrative; instructions for correcting RAPs/claims 1,949 Top HH+H Provider Inquiries

9. 9 Reason for Call Type of Issues# of Calls Claim Overlap Beneficiary inpatient stay, overlapping HH PPS episodes/hospice benefit periods 1,006 Address, Phone, Fax, Web Address CGS mailing addresses, links to information on CMS or CGS Web sites 988 Top HH+H Provider Inquiries (cont.)

10. 10 Provider Inquiry ‘Resources’ www.cgsmedicare.com/hhh/education/materials/ Resources_Most_Common_HHH_Questions.html  List of links, information  Review prior to contacting  Updated quarterly  Based on inquiry data

11. 11 CGS Website www.cgsmedicare.com

12. Primary links on left 12 CGS Website Quick links on right

13. 13 CGS Website Primary links Primary LinkInformation Available News & Publication Recent news, join/update listserv, CGS Bulletins, Cahaba’s Newslines Claims Processing Rates/fee schedules, checking claim status, FISS Claims Processing Issues, common FISS status/locations, RA/ERA, submitting paper claims EDIPC Print, GPNet, PC-ACE Pro32, FAQs Customer Service Phone numbers, Mailing addresses, IVR User Guide, Website feedback, Duplicate remit form EducationCalendar of events, educational materials, FAQs, Advisory Group, new provider resources

14. Primary links (cont.) 14 CGS Website Primary LinkInformation Available EnrollmentElectronic funds transfer (EFT), Enrollment packets, revalidation Financial Audits, cost reports, PS&R, credit balance form, rates/fee schedule AppealsLevels of appeal, redetermination address, reopenings, resources LCDs & Coverage Active LCDs, home health and hospice coverage guidelines, OASIS Medical Review ADRs, Overview of MR (edits, reason codes), signature guidelines

15. 15 ‘News & Publications’ Page Current/recent ListServ messages CGS monthly newsletter Cahaba Newslines

16. 16 Telephone numbers Mailing addresses IVR Guide Duplicate Remit form ‘Customer Service’ Page

17. 17 ‘Events & Education’ Page CGS Resources Upcoming Events

18. 18 ‘Educational Materials & Resources’ Page Scroll down for provider-specific resources FISS Guide MSP Resources

19. www.cgsmedicare.com/hhh/education/materials/ index.html 19 Home Health Education Resources ‘Educational Materials & Resources’ Page

20. 20 ‘HH Claims Filing’ Page

21. 21 ‘HH Claims Filing’ Page

22. 22 ‘HH Coverage Guidelines’ Page www.cgsmedicare.com/hhh/coverage/Home_ Health_Coverage_Guidelines.html

23. www.cgsmedicare.com/hhh/education/materials/ HH_QRT.html 23 ‘HH Quick Resource Tools’ Page

24. 24 ‘FAQs’ Page MSP FAQs HH FAQs Provider Enrollment FAQs

25. ‘LCDs & Coverage’ Page 25 HH PT LCD HH Coverage

26. ‘Medical Review’ Page 26 ADR information Signature requirements

27. CGS Website Search Engine 27 Enter search term and click “Go” Accessible from top of each web page

28. Online Provider Services (OPS) Coming soon! Another means to: » Check patient eligibility » Obtain claim status » View/order remittance advices (RAs) » Check payment floor status » Verify dates/amounts of last 3 Medicare payments Must have EDI Enrollment Agreement on file Watch CGS Bulletins, listservs for more details 28

29. 29 Questions Home Health Provider Contact Center (877) 299-4500