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Resources for the Most Common Home Health and Hospice Medicare Questions

Listed below are the most common inquiries received in the Cahaba Provider Contact Center.

Please click on the links below to access a listing of resources you can use to reduce the number of phone calls to Cahaba for these reasons:

Address/Phone/Fax/Web Address

  • Contact Us Web page of the Cahaba Web Site (phone, fax, mailing address information)
  • CMS Web site pages links (direct links to information posted to the CMS Web site)
  • Provider Contact Information Globe to indicate www link. (CMS Cost Report Overview)  page of the Centers for Medicare & Medicaid Services (CMS) Web site (To determine the contact information for home health and hospice agencies)
    • To access home health information, click on “Home Health Agency” and scroll down to the list of downloads.  Select “HHA Provider ID Information.”
    • To access hospice information, click on “Hospice” and scroll down to the list of downloads.  Select “Hospice Provider ID Information.”
  • MA Claims Processing Contact Globe to indicate www link. listing (To determine the contact information any Medicare Advantage (MA) plan in which your beneficiary is enrolled.  To determine the MA plan contract number, use the “PLAN-ID” field on ELGH page 5 or ELGA page 1.) 
  • Cahaba also maintains “Popular Links” to those Web pages on our Web site that are most searched for by providers. You can access them on our Home Health and Hospice home page

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Beneficiary Demographic Information

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Calculation or Explanation of Payment

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Claims in a Suspended Status/Location (S/LOC)

  • Suspended claims can be identified in the Fiscal Intermediary Standard System (FISS) by the status code "S" (e.g., S B0100).
  • Generally, providers do not need to take action for claims in a suspended S/LOC. All claims will temporarily suspend in different S/LOCs as they process through FISS.

Below are some common suspended S/LOC codes and what they mean:

S/LOC Definition Provider Action Needed?
S B0100 System processingNo
S B6001 Claim needs additional information from provider (ADR). Yes, providers should return the medical documentation within 30 days. Claim will deny on 46th day if documentation not received.
S B90XX (XX=variety of location codes) System is comparing claim data to beneficiary eligibility information posted at the Common Working File (CWF). No
S M0XXX (XXX=variety of location codes) Suspended claims/adjustment requiring manual intervention by Cahaba staff.

No.  Suspended claims/adjustments that require Cahaba staff intervention may be suspended for about 30 days.  Claims with Medicare Secondary Payer (MSP) information may be suspended for more than 60 days.  Providers may call the appropriate Provider Contact Center if their claims have been in the same “S MXXXX” status/location for longer than 30 days, or 60 days for MSP claims.
S MRADJ A Medicare Secondary Payer (MSP) adjustment has been received; claim suspended while awaiting completion. No
S M50MR Medical Review (moves claims to this location once medical documentation has been received.) Please note: the review process may take up to 60 days to complete. No

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Claims Processing Issues

When calling to report or to receive an update about issues with the Fiscal Intermediary Standard System, check the Fiscal Intermediary Standard System Claims Processing Issues Web page, prior to calling Cahaba.

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Correcting Invalid Information Posted to the Common Working File (CWF)

Please be aware that Cahaba is unable to update invalid information posted to the beneficiary’s eligibility file including Medicare Secondary Payer (MSP) records, invalid dates of death, and Medicare Advantage (MA) plan enrollment/termination dates.

  • To update MSP records, contact the Coordination of Benefits Contractor (COBC), at 1-800-999-1118.  For more information about the COBC, review the Contacting the COB Contractor Globe to indicate www link. Web page on the CMS Web site.
  • To update dates of death, or the beneficiary’s name, address, or Medicare entitlement dates, contact the Social Security Administration (SSA) at 1-800-772-1213.
  • To update Medicare Advantage (MA) Plan records, determine the MA plan identification code using the “PLAN-ID” field on ELGH page 5 or ELGA page 1.  Use the MA Claims Processing Contact Globe to indicate www link. listing to determine the contact information for the MA plan posted for the beneficiary.  Contact the MA plan listed to update the beneficiary’s eligibility record.
  • To correct hospice benefit period information, access the information on the Canceling a Notice of Election or Benefit Period Web page.
  • To correct home health episodes, access the information on the Correcting Home Health Episode Information Posted to the Common Working File (CWF) Web page.

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Coverage Issues

Home Health Coverage Guidelines

Hospice Coverage Guidelines

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Electronic Data Interchange (EDI)

Please be aware that Cahaba home health and hospice Customer Service Representatives (CSRs) are unable to assist you with questions about CMS freeware, billing software, connectivity issues or resetting your passwords for the Fiscal Intermediary Standard System (FISS). 

For assistance with these types of issues, please contact a CSR at the EDI telephone number found on the Telephone Us Web page.

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Explanation of RTP Reason Code

After reading through the reason code narrative, you may be able to access additional information for resolving the billing error from the Top Claim Submission Errors and How to Resolve Web page.  For instructions on reviewing reason code narratives for claims in RTP, access the Claims Correction section of the FISS Reference Guide.

The reason codes most often inquired about are:

Return to Provider (RTP) Reason Codes Frequently Asked Questions

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Filing/Billing Instructions

Types of billing instructions most requested:

Home Health

Hospice

Medicare Secondary Payer (MSP)

  • Determining which insurer is the primary payer
    • Use page 1 (Flow Chart) of the Medicare Secondary Payer Billing quick reference tool to determine if Medicare is the primary or secondary payer based on MSP records posted to ELGA/ELGH

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Missing/Invalid Codes

Most common types of claims that have missing or invalid codes:

Adjustments

Also access Adjusting and Canceling Claims online course

 

Home Health

Hospice

Medicare Secondary Payer (MSP)

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Overlapping Benefit Periods, Claims, Episodes, Services

 

Home Health and Hospice

  • Checking Beneficiary Eligibility section of the FISS Reference Guide (see information published on ELGA pages 1, 2, and 4, as well as ELGH page 3 and 9).
  • Access the names, provider numbers, and addresses of hospices, and home health agencies to assist in resolving overlapping claim issues. A resource is available Provider Contact Information Globe to indicate www link. (CMS Cost Report Overview)  page of the Centers for Medicare & Medicaid Services (CMS) Web site.
    • To access home health information, click on “Home Health Agency” and scroll down to the list of downloads.  Select “HHA Provider ID Information.”
    • To access hospice information, click on “Hospice” and scroll down to the list of downloads.  Select “Hospice Provider ID Information.”

Home Health

Additional references for overlapping services due to home health beneficiary-elected transfer, or discharge/re-admission during a 60-day episode of care:

If one of the line item dates of service (LIDOS) on your home health claim is overlapping an inpatient stay, access the information on the Top Claim Submission Errors for Home Health Providers:  Error C7080 Web page.  Cahaba encourages you to use the first Medicare billable visit in the episode as the date of service submitted when billing non-routine or surgical dressing/wound care supplies to avoid errors for overlapping inpatient stays. In addition, please review the information posted to the Impact of an Inpatient Admission During an HH PPS Episode Web page.

If your home health claim was adjusted or rejected due to the dates of service overlapping a Medicare Advantage (MA) plan enrollment period, refer to the information found on the Top Claim Submission Errors for Home Health Providers:  Error U5233 and 7CS21 Web page.

If your home health episode overlaps a hospice benefit period and your services are unrelated to the terminal diagnosis, please review the information found on the Top Claim Submission Errors for Home Health Providers: Error C7010 Web page.

Hospice

Additional references for hospice beneficiary discharge/revocation, or transfer during a benefit period:

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Resolving Rejected Claims


Medicare claims submitted to Cahaba most often reject due to:

  • Duplicates: a second Medicare claim with the same dates of service for the same beneficiary is submitted by a home health or hospice agency.
  • Eligibility: the claim information submitted by the home health or hospice agency does not match the information posted to the beneficiary’s eligibility record at the Common Working File (CWF). For example, a beneficiary has an open Medicare Secondary Payer (MSP) record and the dates of service submitted on the Medicare claim are after the effective date of the record.
    • Cahaba encourages providers to check a beneficiary’s eligibility using the ELGH or ELGA eligibility systems prior to admission and billing each home health episode or hospice Notice of Election (NOE) or claim to Medicare. More information on accessing, reviewing and understanding the information found on these screens is available in the Checking Beneficiary Eligibility section of the FISS Reference Guide.

Depending upon the reason why a claim is rejected, a home health or hospice provider may need to send in a new claim (resubmit), electronically adjust, or send a paper claim adjustment to resolve the original billing error.

Home Health and Hospice Providers

Home Health Providers Only

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Page last updated: July 14, 2010

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