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Last Modified: 10/28/2022 Location: FL, PR, USVI Business: Part A, Part B
Current processing issues for Part A and Part B
The table below provides an at-a-glance look at processing issues being worked currently or resolved recently. To sort by line of business (LOB), status, or date last updated, click on that column's header. Click again to change between ascending or descending order.
LOB
Issue
Resolution
Status
Provider Action
Last Updated
Part A
Reason code 32804 is editing incorrectly on incoming prior hospitalization interim bills. A correction has been developed and is tentatively scheduled to be installed on November 28. We will post an update confirming when the correction is successfully installed.
Open
Providers will be able to resubmit claims after the correction install on November 28.
10/28/2022
Part A
The ESRD Treatment Choices (ETC) Model Performance Payment Adjustment (PPA) - facility component, was implemented with the July 2022 release for the Part A Fiscal Intermediary Standard System (FISS). It was discovered that the claims of ESRD facilities participating in the ETC model are receiving the home dialysis payment adjustment (HDPA) applied in error.
Closed
A correction was installed on October 13. Claims with date of service July 1 and after will be automatically reprocessed.
10/25/2022
Part A
Outpatient prospective payment system (OPPS) claims with dates of service in calendar year (CY) 2022 billed with modifier JG, received differential payment rates for 340B-acquired drugs. On September 28, the US District Court for the District of Columbia vacated the differential payment rates for 340B-acquired drugs in the CY 2022 OPPS rule with comment period.
Closed
Providers may submit adjustments on any claim submitted for date of service in 2022 paid before September 28,2022, with the modifier JG by submitting the type of bill (TOB) XX7 with condition code D9 and remarks indicating “340B adjustment.” Timely filing rules will apply when submitting adjustments, so we recommend adjusting as soon as possible. If adjustments are submitted beyond timely filing, then the TOB will need to be XXQ with the appropriate coding and the remarks indicating “340B adjustment.” The modifier JG can remain on the claim, but the reduction will no longer be applied. We will not perform mass adjustments on impacted claims with a 2022 date of service paid before September 28, 2022. Claims paid on or after September 28, will be automatically adjusted.
10/21/2022
Part B
CMS identified a national system issue which may have inadvertently adjusted previously processed Part B claims with dates of service (DOS) on or after January 1, 2021. These adjustments processed on July 29 through August 2, 2022. Impacted codes included the following: 99202-99205, 99211-99215, 99324-99328, 99334-99337, 99341-99345, 99347-99350, 99354-99355, 99495-99498, G0402, G0438, G0439, 99415, 99416.
Open
Most of the claims that inadvertently adjusted did not result in a change in payment; therefore, most providers were not impacted and no actions are required.
8/17/2022
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.