Home Health & Hospice Week

Don’t let new claim element slow your cash flow in the new year.

Make sure you add new state and county codes to your claims come Jan. 1, or you’ll not just miss out on potential extra reimbursement — you’ll see your claims returned.

The Bipartisan Budget Act of 2018 enacted in February requires that for home health services furnished on or after Jan. 1, 2019, home health claims must contain “the code for the county (or equivalent area) in which the home health service was furnished,” the Centers for Medicare & Medicaid Services says in a new MLN Matters article.

“In response, Medicare requested that the National Uniform Billing Committee create a new code to meet this requirement,” CMS continues. “This new value code 85 is effective on January 1, 2019, and is defined as ‘County Where Service is Rendered.’”

The requirement goes with the new plan, also contained in BBA ’18, to phase out the rural add-on over five years and increasingly restrict the add-on each year.

Do this: “Providers should report the Federal Information Processing Standards (FIPS) State and County Code of the place of residence where the home health service is delivered,” CMS instructs in the article MM10782. If you don’t, or a code is invalid, your Medicare Administrative Contractor will return the claim to you, CMS warns.

The FIPS code requirement applies to all agencies, not just those in rural areas, emphasized a CMS official in the Nov. 14 Home Health Open Door Forum. Even if you won’t get a rural add-on boost, you still will need to include your FIPS code on your claim.

Reminder: BBA ‘18 reduced the add-on to 1.5 percent in 2019 and 0.5 percent in 2020 for agencies “in the highest quartile of all counties ... based on the number of Medicare home health episodes furnished per 100 individuals.” But in areas with “a population density of 6 individuals or fewer per square mile,” the add-on will be 4 percent in 2019, 3 percent in 2020, 2 percent in 2021 and 1 percent in 2022, the law says. All rural agencies not fitting in those two categories will see an add-on of 3 percent in 2019, 2 percent in 2020, and 1 percent in 2021.

FIPS codes are at www.census.gov/2010census/partners/pdf/FIPS_StateCounty_Code.pdf, CMS notes in CR 10782 released Nov. 15.

Note: The MLN Matters article is at www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM10782.pdf.