Medicare Claims Processing Manual Updated

CMS has published an update to the Claims Processing manual to include billing instructions to assist providers in preparing demand bills when the dates of requests by the State Medicaid program do not correspond to dates of existing episodes of care. It also resolves a discrepancy between Medicare instructions for reporting charges and the requirements of the HIPAA transaction standard.

The 837 requires that the Total Charges field always be reported (and zero is an acceptable value,) while Medicare’s instructions since 2000 stated the field may be zero or blank. The recently published transmittal corrects this discrepancy by stating that HHAs must report zero charges on the 0023 revenue code line.

In addition to the above changes, specific examples of non-covered charges on HH PPS claims were added to the Non-Covered Charges Requirement section:

  • Visits provided exclusively to perform OASIS assessments
  • Visits provided exclusively for supervisory or administrative purposes
  • Therapy visits provided prior to the required re-assessments

While CMS has not yet updated the link included on the Internet Only Manuals section of their website (, they have included an updated copy of the Claims Processing manual in the transmittal they published on December 22nd. The full transmittal is available here. The related MLN Matters article is available here.