Text Size

  • Increase
  • Decrease
  • Normal

Current Size: 100%

FISS Billing


To: NHPCO Members From:
NHPCO Health Policy Team Date: October 23, 2012

FISS Billing Glitches for Occurrence Code 55 and Referring Physician

CMS released a quarterly update to the FISS system on October 1, 2012.  As a result of the update, two billing glitches occurred and needed a fix.

  1. Occurrence Code 55 was not processing properly in the 5010 form.  RESOLUTION:  A patch has been provided that will allow claims to be submitted with occurrence code 55 via the PC-Ace Pro32.  Download the fix from the appropriate MAC website.  
  2. Medicare home health and hospice claims have been incorrectly rejecting based on referring provider information.  RESOLUTION:  The issue has been resolved.  Providers can resubmit their claims for payment.

We have now been alerted by every Medicare Administrative Contractor (MAC) that the billing glitches that have kept providers from submitting claims to Medicare through their MAC since October 1, 2012 have been resolved. 

CMS in Baltimore reports that the fix was scheduled to be implemented on Friday, October 19.  Over the past weekend, each of the MACs did the necessary testing to ensure that the “fix” was working and notified NHPCO yesterday, Monday, October 22, 2012, that the problems have been resolved.

For more information on the patch and what your hospice should do,  find your Medicare Administrative Contractor below and click on the link for further directions.

CGS Administrators

National Government Services (NGS)

Palmetto GBA (PGBA)

  • Jurisdiction 11 -- Home Health and Hospice Home Page Click on EDI in left column menu and click on “System Status” and go to the EDI System Status Log just below the “close window” bar.   Providers are instructed to resubmit claims that have been held due to this FISS processing error.

-###-

Any questions from providers may be directed to regulatory@nhpco.org. 

Category: 
Regulatory