HCFA clarifies through’ date
The Health Care Financing Administration (HCFA) has released new information regarding the Home Health Prospective Payment System (HH PPS):
• Removal of home health PPS billing instruction. Based on input from home health agency (HHA) providers and trade associations, HCFA has learned that many [home health agencies] HHAs did not prepare their billing systems to reflect Medicare’s instruction that on HH PPS claims the claim "through" date must match the latest line item date of service. As a result, many HH PPS claims have been returned to the provider for correction. Many HHAs indicated that this instruction conflicted with their clinical documentation practices, which may record a discharge date that is later than the last visit to the beneficiary. HCFA has re-evaluated the need for this billing instruction and has determined that the instruction can be removed, along with the editing in Medicare systems that enforces it.
A future revision to both the Medicare Inter-mediary Manual and the Home Health Agency Manual will formally remove this instruction. In the meantime, HCFA instructed the Regional Home Health Intermediaries to disable the edits that enforce the instruction effective Wednesday, Nov. 29. HHAs do not need to alter their billing systems to comply with the instruction in the future. HHAs whose claims have been returned to them because of the edit that enforced the instruction, may resubmit those claims immediately. Claims affected in the Fiscal Intermediary Standard System were returned by an edit identified with reason code 31053. Claims affected by the Arkansas Part A Standard System were returned by an edit identified as 1C3C.
• Electronic mailbox for HH PPS questions. HCFA has created an electronic mailbox for provider billing questions regarding the HH PPS. If after reviewing instructions and training materials on HCFA’s Web site (www.hcfa.gov/medlearn/refhha.htm), you have unanswered questions about HH PPS billing, you may submit them to [email protected]. Questions received in this mailbox will be answered in the order received.
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