Billing-Requirements

New Billing Requirements in July for Location of Services on Claims

Home Health Q Codes.

CMS recently rescinded part of the requirements described in this blog, please see this updated blog article for full details.

Home health Agencies (HHAs) will need to begin reporting in July, new codes indicating the location where services were provided and indicating whether services were added to the HH plan of care by a physician that did not certify the plan of care.

Specifically, HHAs must report where home health services were provided on home health claims, using Q codes Q5001, Q5002, and Q5009. The definitions of these codes were revised effective April 1, 2013 as follows:

  • 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 should be reported along with the first billable visit in an HH PPS episode. In addition to reporting a service line according to current instructions, 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 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.

HHAs will also need to report when there are changes/additions to the plan of care by a physician other than the certifying physician using a modifier to indicate changes/additions to the plan of care by a physician other than the certifying physician. A modifier will need to be appended to the HCPCS G code describing any visits added to the plan of care by that physician. CMS will publish information on the modifier in the March 31rst HCPCS update.

The effective date is for all episodes beginning on or after July 1st, 2013. HEALTHCAREfirst will make any necessary programmatic changes to the software to support the new billing requirements in advance of the effective date. Once implemented additional information will be provided to providers using HEALTHCAREfirst software programs via release notes.

For full details click here.

Data Reporting on Home Health Prospective Payment System (HH PPS) Claims click here.

February 15, 2013
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