Information About Home Health Ordering/Referring/Attending Physician Adjustments

From October 1, 2018, through April 22, 2019, the home health ordering/referring/attending physician reason code 32072 was not editing correctly. This allowed claims containing a terminated attending physician to incorrectly pay. These claims should have denied.

In the beginning of May, a Fiscal Intermediary Shared System (FISS) utility was initiated to adjust claims that should have originally denied with reason code 32072. The utility captured some claims that it should not have, but the adjustments did process properly. This will cause unnecessary adjustment activity on remittance advices. However, there is no impact of incorrect payments. This may continue until all of the adjustments finalize. We apologize for any inconvenience this may cause.

The adjustments (32I type of bill) fall into three categories:

  1. Adjusted in error — the attending physician is active in the Provider Enrollment, Chain, and Ownership System (PECOS) at the start of care. No payment change between the original claim and the adjustment. However, these will show adjusted on remittance advices.
  2. Adjusted correctly — the attending physician was inactive in PECOS at the start of care. The adjustment is denying with reason code 32072 and payment is being recouped correctly. For more information on ordering/referring/attending denials, please visit the Ordering/Referring/Attending Physician Claim Denials article.
  3. Pending claims — these are editing with other reason codes and are being suspended.  Palmetto GBA is identifying and deactivating these claims. These claims will be adjusted in June.

Source: Palmetto GBA