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. Note: Providers do not need to take any action on the claims with the following reason codes.
| Provider Types Affected | Issue / Reason Code | Impact | Status | Resolved |
|---|---|---|---|---|
| Home Health | The new “Home Health Payment Totals Inquiry” screen, (FISS Option 67) does not display correct information to allow providers to track outlier payment and HH PPS payment totals. Payment totals will display, but the data disappears at the first of each month. | Providers are unable to track outlier payment and HH PPS payment totals to ensure that outlier payments comprise no more than 10% of the HHA’s total HH PPS payments for the year. | 03/03/2010—This issue has been reported to the FISS maintainers. | 03/10/2010—This issue has been resolved. Providers can now view the “Home Health Payment Totals Inquiry” screen, (FISS Option 67) to track outlier payment and HH PPS payment totals. For additional information about this FISS screen, refer to the “Inquiry Menu” section of the FISS Reference Guide. |
| Home Health | FISS is recoding the HIPPS code incorrectly on some claims processed on or after January 1, 2010, when there are more than 20 therapy visits billed on the claim. | When a HIPPS code indicates less than 20 therapy visits, but the claim actually contains more than 20 therapy visits, FISS recodes the HIPPS code with a ‘5’ as the first position; however, FISS is not recoding the second, third, or fourth positions of the HIPPS code. | 3/10/2010—No Update 3/3/2010—No Update 02/22/2010—This issue has been reported to the FISS maintainers. Until this issue is resolved, providers can submit an adjustment to correct the HIPPS code based on the number of therapy visits billed to receive the correct payment. For additional information, refer to the article, Home Health Claims Receiving Incorrect Payments. |
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| Home Health | Final claims and adjustments that are recoded with a ‘5’ as the first digit of the HIPPS code are continually recycling in FISS with reason code U524P and U524Q which indicate the final or LUPA claim has a HIPPS code that is for an early episode and should be a late episode, or it has a HIPPS code that is for a late episode and should be an early episode. | Final claims and adjustments are cycling in status/location S B9000 and S B9099. This issue may affect claims and adjustments with a ‘From’ date of service of 1/1/2008 and after. | 3/3/2010—No Update 2/22/2010—This issue has been reported. Medicare staff is currently working on a manual process to override some final claims and adjustment that are recycling in FISS with reason code U524P. |
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| Home Health | Incorrect payments. | Home health partial episode payment (PEP) claims are receiving incorrect payments. | 3/3/2010—No Update 02/22/2010—No update 02/10/2010—No update. 01/04/2010—A resolution to this issue was implemented with the January 2010 system release. However, the PEP amounts being paid are now just pennies off from the CMS Pricer amount that you would expect. The FISS maintainer has been made aware of the differences between the CMS Pricer and the PEP payments. Mass adjustments will be delayed until this issue is resolved. 11/02/2009—A resolution to this issue is scheduled for implementation on March 1, 2010. PEP claims will continue to receive incorrect payments until implementation occurs. At that time, Cahaba will initiate mass adjustments to all claims and adjustments that were paid incorrectly. 10/20/2009— This issue has been reported to the Centers for Medicare & Medicaid Services (CMS) and the FISS maintainers. Additional information will be provided as it becomes available. |
310/2010—The Centers for Medicare & Medicaid Services (CMS) will be correcting the CMS Pricer software to match the FISS software. The correction will be implemented with the April 4, 2010, system release. Providers do not need to take any action. Cahaba will initiate adjustments to the affected claims. |
| Home Health | When a final claim is rejected and an ‘X’ displays in the TPE-TO-TPE (tape-to-tape) field, FISS applies a cancel document control number (DCN) to the Request for Anticipated Payment (RAP); however, a cancel date is not applied to the RAP. When the final claim is resubmitted, it moves to the RTP file with reason code 38107 or U5391. | FISS is unable to match the final claim with a processed RAP. | 10/6/2009—A resolution to this issue is scheduled for implementation with the January 2010 system release. 9/17/2009—No update. 8/6/2009—This issue has been reported to the FISS maintainers. Providers should review the “Top Claim Submission Errors for Home Health Providers: Error 38107” Web page to determine if your claim received 38107 or U5391 appropriately. If you feel your claim went to RTP inappropriately, please contact our Provider Contact Center at 877-299-4500 for further assistance. |
02/22/2010— 02/10/2010—
01/04/2010—This issue has been resolved with the implementation of the January 2010 system release. |
Page last updated: March 11, 2010
