Skip to main content

Home Health (HH) Billing Updates'2022

Correction to Home Health (HH) Billing for Denial Notices

The implementation of the one-time home health Notice of Admission (NOA) in calendar year 2022, every claim for a home health period of care first required the submission of a Request for Anticipated Payment (RAP).

Correction to the Calculation of 60-Day Gaps in Home Health Services

A sequence of related home health periods of care is defined beginning with an admission to home health services and ending when there is a 60-day gap in home health services.

This 60-day gap is used by Medicare systems for two purposes.
  • It is used to validate whether a home health period of care is correctly coded as an early or later period.
  • It is also used to identify early periods that should pay a Low Utilization Payment Adjustment (LUPA) add-on amount.
  • Medicare administrative contractors recently identified a minor variance between the way the 60-day gap is counted and used for these two purposes.
  • The requirements below revise the counting method used for identifying LUPA add-ons, in order to create consistency.

Submission and Processing

In order to submit a no-payment bill to Medicare under HH PPS, providers must use TOB 0320, and condition code 21.

The claims with condition code 21 and any other TOB will be returned to the provider for correction. 
A Notice of Admission (TOB 032A) is not required before the submission of a claim with TOB 0320 and condition code 21.

The claims to process through the subsequent HH PPS edits in the system, providers are instructed to submit a 0023 revenue line on the claim. 
If no OASIS assessment was done or if the HHA chooses not to perform payment grouping before submitting the claim, report any valid HIPPS code.

The claim must meet other minimum Medicare requirements. If an OASIS assessment was done and the HHA chooses to perform payment grouping for their internal accounting purposes, the HHA may report the resulting HIPPS code.

Simultaneous Covered and Non-Covered Services

In some cases, the providers may need to obtain a Medicare denial notice for non-covered services delivered in the same period as covered services that are part of an HH PPS period of care.

In such cases, the provider should submit a non-payment bill according to the instructions above for the non covered services alone, AND submit the appropriate NOA and claim for the HH PPS period of care.

The period billed under the HH PPS claim and the non-payment bill should be the same. Medicare standard systems and the CWF will allow such duplicate claims to process when all services on one claim are non-covered.

Custodial Care under HH PPS, or Termination of the Benefit during a Period

In certain cases, Medicare allows the use of no payment claims in association with an ABN involving custodial care and termination of a benefit during a period of care.

This does not apply to cases in which a determination is being requested as to the beneficiary’s homebound status at the beginning of a period of care; there an ABN must be used assuming a triggering event occurs (i.e., the initiation of completely non-covered care).

However, in cases where the HH plan of care prescribes only custodial care, or if the benefit has terminated during a previous period, and the physician, beneficiary, and provider are all in agreement the benefit has terminated or does not apply, home health agencies (HHAs) can use,
  • The ABN for notification of the beneficiary,
  • A condition code 21 no-payment claim to bill all subsequent services.

Popular posts from this blog

CPT Changes - New CPT Codes '2022

Glimpses of CPT Codes Updates - Effective from January 1st 2022 There are more than 400 codes are changes in 2022 from AMA. Total number codes are changed 405 and including of followings, New Codes -  249  Revised Codes - 93  Deleted Codes - 63 More than 40% of the editorial changes are tried to new technology services described in Category III CPT codes and the continued expansion of the proprietary laboratory analyses section of the CPT code set. Five new CPT codes are created for therapeutic remote monitoring codes 98975, 98976, 98977, 98980 and 98981 to increasingly important avenue of patient care especially during the COVID-19 pandemic. Five new CPT codes are created for complex care management codes 99424, 99425, 99426, 99427 and 99437 a nd there are some changes in chronic care management CPT codes as well. Six new CPT codes are created for Cardiac Catheterization codes 93593, 93594, 93595, 93596, 93597 and 93598 for congenital heart defects. Also, there are some changes in ele

Annual Preventive and Wellness Visit Service

Preventive Service Codes The annual preventive exam is a periodic, comprehensive preventive medicine evaluation (or reevaluation) and management of the patient. The CPT Code selection is based on whether the patient is receiving an initial visit -"New Patient" or a periodic - "Established Patient" preventive service, as well as the patient’s age. Initial Visits - 99381, 99382, 99383, 99384, 99385, 99386, 99387 Subsequent Visits - 99391, 99392, 99393, 99394, 99395, 99396, 99397 The Medicare insurance would be covered by "G" codes instead of the above codes. The details below, Welcome to Medicare - G0402 (Within the one year from the patient enrolled in Medicare) Initial Annual Wellness Visit - G0438 (After the 1st year of enrollment) Subsequent Annual Wellness Visit - G0439 Initial Visits Initial comprehensive preventive medicine evaluation and management of an individual including an" age and gender appropriate history, examination, counseling/anticip

CPT Changes - Deleted CPT Codes'2022

 CPT Code CPT Description 0191T Insertion of anterior segment aqueous drainage device, without extraocular reservoir, internal approach, into the trabecular meshwork; initial insertion 01935 Anesthesia for percutaneous image guided procedures on the spine and spinal cord; diagnostic 01936 Anesthesia for percutaneous image guided procedures on the spine and spinal cord; therapeutic 0208U Oncology (medullary thyroid carcinoma), mRNA, gene expression analysis of 108 genes, utilizing fine needle aspirate, algorithm reported as positive or negative for medullary thyroid carcinoma 0290T Corneal incisions in the recipient cornea created using a laser, in preparation for penetrating or lamellar keratoplasty (List separately in addition to code for primary procedure) 0355T Gastrointestinal tract imaging, intraluminal (eg, capsule endoscopy), colon, with interpretation and report 0356T Insertion of drug-eluting implant (including punctal dilation and implant removal when performe