Our home health claims are receiving Partial Episode Payments (PEPs) or billing errors for overlapping a Medicare Advantage (MA) plan. How can we get our episodes fully paid by Cahaba?
When a beneficiary under Medicare fee-for-service (FFS) coverage elects a MA Plan during a Home Health Prospective Payment System (HH PPS) episode, the episode will end and be proportionally paid according to its shortened length (a partial episode payment (PEP) adjustment). The MA Plan becomes the primary payer effective with the MA Plan enrollment date. Cahaba cannot make payments under the HH PPS or any other Medicare Part A or Part B payment system for dates of service falling within a beneficiary’s enrollment in an MA plan, unless the beneficiary has also elected the Medicare hospice benefit. For more on steps HHAs can take to avoid errors due to a beneficiary’s enrollment in an MA plan, see the Top Claim Submission Errors for Home Health Providers : Error U5233 and 7CS21 Web page. In addition, see the Medicare Claims Processing Manual, (Pub. 100-04, Chapter 10, § 10.1.5.2 & 80) for more information about MA plans and their impact on HH PPS episodes. (April – June 2009 FAQ – Revie
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