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Fiscal Intermediary Standard System Claims Processing Issues

The following list provides you with the most current status of claims processing issues that have been reported to the Fiscal Intermediary Standard System (FISS) maintainers and the Centers for Medicare & Medicaid Services (CMS). Please check here often for updates before contacting the Provider Contact Center with questions. 

 

Provider Types Affected Issue / Reason Code Impact Status Resolved
Home Health The PC Pricer for dates of service on or after April 1, 2010, is causing incorrect payments on Low Utilization Payment Adjustment (LUPA) claims. PC Pricer is calculating a payment that is less than what FISS is paying.   08/10/2010—This issue has been reported to the Centers for Medicare & Medicaid Services (CMS).  The payment calculation performed by FISS is correct.  The PC Pricer payment calculation is in error.  CMS will update the PC Pricer to correct the payment calculation and post an updated version to the Home Health Prospective Payment System (HH PPS) PC Pricer Globe to indicate www link. Web page.  
Home Health When an adjustment is made to change the HIPPS code, the payment amount does not change.  This occurs only on claims where the PC Pricer changed the original HIPPS code that was submitted. The adjustment to change the HIPPS code processes with the same payment amount as the original claim.

08/10/2010—No update.

7/14/2010—This issue has been reported to the FISS maintainer.  However, until a resolution is provided, our suspense staff is able to correct this issue; therefore, if you submitted an adjustment to change the HIPPS code, but the reimbursement did not change, contact the home health Provider Contact Center at 1-877-299-4500 for assistance.

 
Home Health FISS is incorrectly calculating Partial Episode Payment (PEP) claims that have a type of bill 3XG and the Patient Status code 06.
 When comparing the PC Pricer calculation with the payment being made by FISS, there is a difference of a dollar or two.  The FISS payment is correct.

08/10/2010—No update.

07/14/2010—This issue has been reported to the FISS maintainer.  It is anticipated that this issue will be resolved with the implementation of the January 2011 PC Pricer update.

 
Hospice Hospice claims are receiving reason code U5181 incorrectly.  Reason code U5181 requires that occurrence code 27 and date of certification/recertification is reported when the date of certification/recertification falls between the “From” and “To” dates on the claim. Hospice claims are incorrectly receiving reason code U5181 on adjustments that contain occurrence code 42 and the date of revocation.  In addition, when a hospice patient transfers agencies, the first claim submitted by the receiving hospice incorrectly receives reason code U5181. 07/14/2010—This issue has been reported to the Common Working File. 

08/10/2010—This issue has been resolved.  If you have claims in the Return to Provider (RTP) file (T B9997), that you feel received reason code U5181, inappropriately, F9 the claims to continue processing.  If you continue receiving reason code U5181, refer to the Top Claim Submission Errors for Hospice Providers: Error U5181 page on our Web site.  
Hospice Hospice claims with occurrence span code 77 are receiving reason code 34923 incorrectly.  The number of noncovered units should be equal to the non-covered days identified by the date span reported with the occurrence span code 77. It appears that FISS is also including units reported on the discipline lines when counting the days.  This causes the hospice claim to receive reason code 34923 incorrectly.  The claims are being suspended to status/location S M4923.   06/23/2010—This issue has been reported to the FISS maintainer.  The resolution to this issue is scheduled to be implemented with the October 2010 system release.

07/14/2010—Resolution to this issue is scheduled for implementation with the December 2010 system release.

 

Page last updated: August 13, 2010

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