Home Health Billing Dispute Resolution Requests

Good Afternoon MFS bloggers,

PGBA recently published an article regarding the fact that providers sometimes experience situations where they are unable to resolve a billing dispute with another provider either due to overlapping dates of service or sequential billing.
Home health providers should ensure that a patient’s Medicare eligibility records are reviewed before the patient is admitted. If the patient’s Medicare eligibility records reflect that care is or was being provided by another provider, and the records do not reflect that the previous provider has finalized their billing, the receiving provider is responsible for contacting the existing/previous provider to request that they complete their billing.

What should the agency do in case there is a dispute?
Should a dispute arise, both agencies are required under Medicare regulations to make an attempt to resolve the issue between them. If the agencies are unable to resolve the dispute, Palmetto GBA may be contacted for assistance.
Palmetto GBA will work with both agencies to settle the dispute. Providers seeking assistance from Palmetto GBA to resolve a billing dispute should complete the Billing Dispute Resolution Request Form found at the PGBA-RHHI website (forms.) All information on the form is required to assist the provider.

Note: Providers are not required to use the form, but all requests must include the elements contained in the form. If the form is incomplete or the written request does not include all the required information, the request will be returned to the provider. Providers should also note that the request to settle a billing dispute must pertain to claims that are within the timely filing requirements unless the situation falls within the exceptions to grant an extension to the timely filing requirement. Please refer to the Timely Filing Guidelines Job Aid for additional information on the timely filing requirements.

Upon receipt of the completed form or a written request that includes all the required information, Palmetto GBA will take the necessary steps to assist the provider with resolving the situation.

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