Home Health & Hospice Week

You also must report when a non-certifying doc adds to the care plan.

Get ready for new reporting requirements on your home health claims. Effective July 1, you must now report certain codes to show the location where services were provided -- or risk Medicare denials.

According to Change Request 8136, issued on Feb. 1, home health episodes beginning on or after July 1 must include certain Healthcare Common Procedure Coding System codes to report where the services were provided:

• Q5001 (Hospice or home health care provided in patient’s home/residence)

• Q5002 (Hospice or home health care provided in assisted living facility)

• Q5009 (Hospice or home health care provided in place not otherwise specified (NO))

Hospice providers have been reporting these codes on claims since 2007, but now Medicare wants home health agencies to report them as well, Palmetto GBA explains. Medicare wants to begin capturing data on where home health services are provided, as well as when a physician (other than the certifying physician) changes or adds to the plan of care.

When To Report These Q-Codes

You must report the Q-code along with the first billable visit in a Home Health Prospective Payment System episode, instructs the Centers for Medicare & Medicaid Services. You’ll need to report an additional line item with the same revenue code and date of service, reporting one of the three Q-codes, one unit, and a nominal charge like a penny.

Snag: But if the location where services were provided changes during the HH PPS episode, you must report the new location with an additional line that corresponds to the first visit provided in that new location, Palmetto says.

Beware: Q-Code Reporting Is Not Optional

If you don’t include these Q-codes on your claims, your claim will be returned, CMS warns. To avoid returned claims, be sure you:

• Report Q5001, Q5002 or Q5009 on your HH PPS claims containing revenue code 042X, 043X, 044X, 055X, 056X or 057X;

• Match the line item date of service for the line reporting the Q-code to the earliest dated home health visit line; and

• Don’t report the same HCPCS code on consecutive dates when more than one line on your HH PPS claim reports Q5001, Q5002 or Q5009.

Pay attention: "Claim lines reporting Q5001, Q5002 or Q5009 are not included in the visit counts passed to the HH Pricer, nor are they counted in medical policy parameters that count number of visits," Palmetto says.

Your Additional Reporting Requirements Don’t Stop There

What’s more: Also effective for July 1, you must now append a new modifier to the HCPCS G-code to describe any visits that a physician other than the certifying physician adds to the plan of care, CMS states.

Right now, CMS is dubbing this Modifier XX, but you’ll get the actual modifier and its definition when the agency publishes the HCPCS update on March 31. CMS will also reissue CR 8136 with the final modifier information at that time.

Resource: You can view CR 8136 at www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R2650CP.pdf.