On February 3, 2004, CMS announced a claims processing problem where some hospital inpatient claims were denied and will need to be resubmitted for payment. CMS implemented changes to its claims processing system that included a new edit against an existing discharge or transfer claim where the patient status code submitted on the existing discharge or transfer claim does not match the incoming admission claim. The denial occurs incorrectly when a home health episode is involved in the sequence of events after the patient is discharged from an inpatient hospital stay. When CMS implemented the changes, it failed to program the claims processing system to consider all qualifying claims that may have already been paid or claims that were received out of sequence. The problem will be corrected by February 9, 2004, but providers will need to resubmit Medicare claims denied. Further information regarding this claims processing issue can be found at http://www.cms.hhs.gov/providers/hipps/hipps_cp_problem.asp.
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