Palmetto GBA Addresses Wrongly Denied Claims Related to Reason Code 32072

HCAF received word from the National Association for Home Care & Hospice (NAHC) that Palmetto GBA released information related to those claims that were previously denied due to the incorrect application of the PECOS claims edit. Please note that this does not change the recent release of the CMS Final Rule on Ordering and Referring Physicians and the plans to turn on the PECOS claims edit in the near future. This only affects claims that were denied with the Reason Code 32072.

From: NAHC Regulatory Affairs

Palmetto GBA asked NAHC to forward the following message about denials that were issued based on the incorrect application of a PECOS edit. The edit has been turned off. However, in order to received payments for claims that were wrongly denied, agencies must follow the following instructions.

(NOTE: CMS issued a final rule on Ordering and Referring Physicians and plans to activate PECOS edits in the near future, possibly as early as June 26, 2012. Home health agencies should take steps to ensure that ordering physicians who are not enrolled in Medicare, officially opted out of Medicare, or filed an 855O limited enrollment form know that Medicare will not cover home health, DMEPOS, lab and imaging services.)

Subject: Reason code 32072 denials

Palmetto GBA recently denied several claims with Reason Code 32072. These claims denied in error stating:

‘FOR HOME HEALTH CLAIMS (32X AND 33X) THE ATTENDING PHYSICIAN ON THE PECOS PHYSICIAN FILE HAS A TERMINATION DATE PRESENT AND IT IS EQUAL TO OR LESS THAN THE CLAIM FROM DATE OF SERVICE.’

In order that providers are paid correctly, we have/are taking the following actions:

  1. We have cancelled the RAP claims. Providers need to refile their RAP claims.
  2. We are adjusting the final claims. We anticipate completing all adjustments within two weeks. No provider action is needed on the final claims.

Thank you for your patience as we worked to resolve this issue.

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