Home Health Policy & Claims Processing Change Requests.

A number of Change Requests were issued by CMS on several home health policy and claims processing issues. These changes were effective January 1, 2015.

Following is a summary of those Change Requests as a reminder to you:

Change Request 8699 – Preventing Duplicate Payments When Overlapping Inpatient and Home Health Claims Are Received Out of Sequence

This Change Request improves safeguards to prevent payment of home health services when a beneficiary is an inpatient of a hospital or skilled nursing facility.

CMS has directed MACs to implement edits that will prevent home health claims from processing with dates of service overlapping an inpatient stay. The Change Request indicates that if a home health PPS claim is received, and CWF finds dates of service on the home health claim that falls within the dates of an inpatient, SNF or swing bed claim (not including dates of admission and discharge and dates of any leave of absence), Medicare systems will reject the home health claim. The home health agency may submit a new claim removing any dates of services within the inpatient stay there were billed in error.

If the home health PPS claims is received first and the inpatient hospital, SNF or swing bed claims is received later, but contains dates of service duplicating dates of service in the home health episode period, Medicare systems will adjust the previously paid home health claim to non-cover the duplicated dates of service.

Click here to review CR 8699 in its entirety.

Change Request 8710 – Preventing Payment on Requests for Anticipated Payment (RAPs) When Home Health Beneficiaries are Enrolled in Medicare Advantage (MA) Plans

This Change Request modifies the Original Medicare systems to ensure RAPs with “From” dates falling within Medicare Advantage (MA) enrollment periods are processed bur are paid at zero percent. This allows the final claim to be received and rejected appropriately.

In addition, the change request adds remittance advice coding to zero-paid RAPs processed in Medicare Secondary Payer situations in order to distinguish between the two.

Click here to review CR 8710 in its entirety.

Change Request 8813 – Diagnosis Reporting on Home Health Claims

This Change Request adds editing for principal diagnoses that are not appropriate for reporting on the home health claim. MACs will return to provider (RTP) home health claims receiving the “Manifestation code as principal diagnosis” edit. This serves to ensure greater compliance of coding guidelines for primary diagnosis codes.

The principal diagnosis reported on the home health claim should be the ICD-9-CM code that is most related to the current home health plan of care. Home health agencies should not submit manifestation codes as the primary diagnosis.

Click here to review CR 8813 in its entirety.