Billing-Changes

CMS Rescinds Part of the July 1st Billing Change Requirements

Providers Will Need to Report New Codes for Episodes.

Back in February we first reported that Home health Agencies (HHAs) would need to begin reporting in July:

  • new codes indicating the location where services were provided
  • and indicate whether services were added to the HH plan of care by a physician that did not certify the plan of care with modifiers.

Transmittal 2650, dated February 1, 2013, is being rescinded and replaced with Transmittal 2680, dated April 4, 2013, to remove the second bullet/requirement above for indicating whether services were added to the HH plan of care by a physician that did not certify the plan of care along with the modifiers that were being used to indicate this. The transmittal also includes policy language revisions regarding the use of the Q codes. All other information remains the same.

Providers will now only need to report new codes for episodes beginning on or after July 1, 2013, indicating where home health services were provided:

  • Q5001: Hospice or home health care provided in patient’s home/residence
  • Q5002: Hospice or home health care provided in assisted living facility
  • Q5009: Hospice or home health care provided in place not otherwise specified (NO)

The location where services were provided must always be reported along with the first billable visit in an HH PPS episode. In addition to reporting a visit line using the G codes as described above, HHAs must report an additional line item with the same revenue code and date of service, reporting one of the three Q codes (Q5001, Q5002, and Q5009), one unit and a nominal covered charge (e.g., a penny). If the location where services were provided changes during the episode, the new location should be reported with an additional line corresponding to the first visit provided in the new location.

HEALTHCAREfirst will make any necessary programmatic changes to the software to support the new billing requirements in advance of the July 1, 2013 effective date. Once implemented additional information will be provided to providers using HEALTHCAREfirst software programs via release notes.

April 4, 2013

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