CMS-Announcement

MACs to Update Systems for New Home Health Claim Checks

Home Health Business Intelligence Tools Can Help.

CMS recently published a new transmittal that notified agencies that the Medicare administrative contractors (MACs) are in the process of updating their systems to check the HIPPS codes on home health claims against OASIS assessments before paying the claim. No time table has been set currently on when Home Health claim edits will be turned on. The first phase begins Oct. 1 and only includes inpatient rehabilitation facilities. CMS will issue instructions to test and activate the Home Health Edits at a later time.

What this means for you as an agency is that it will become even more important than ever before to make sure your OASIS data is as accurate as possible and that your bills and OASIS are consistent.  When the Home Health Claim Checks edits are implemented, MACs will check for discrepancies between the HIPPS code on the claim and the assessment data. If such a discrepancy is found, the contractor will pay for the episode based on the assessment rather than the claim. The change is designed to validate providers’ HIPPS calculations and check for timely submission of the OASIS.  Late and missing OASIS submissions have recently been under scrutiny by the HHS Office of Inspector General.

For additional information on the changes, view the transmittal here.

HEALTHCAREfirst will send out additional details once a timeline for the Home Health edits has been determined for recipients of the blog and will send providers using HEALTHCAREfirst software information about additional checks implemented to assist with these changes.

HEALTHCAREfirst clients that use the Episode Master component of Business Intelligence already receive improved OASIS quality through patient assessment analysis and clinical irregularities identification. When irregularities are detected, Episode Master suggests edits that can be made to ensure the patient receives appropriate care and your clinicians can use the information in the reports as a learning tool and management.

June 11, 2012

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