Home Health & Hospice Week
Learn This New Code For Billing Without Skilled Visits
CMS aims to minimize review.
Usually home health episodes must contain a skilled visit to be billable, but there are exceptions to the rule. Starting in July, a new code will allow those exceptions to bill without unnecessary denials and review.
“A new condition code 54 … is defined as ‘No skilled HH visits in billing period. Policy exception documented at the HHA,’” the Centers for Medicare & Medicaid Services says in a new MLN Matters article. “Submission of this code will streamline claims processing for both the payer and provider. Claims without skilled visits that are submitted without the new condition code will be returned to the provider.”
When a claim gets returned for having no skilled service, the agency can “Add any accidentally omitted skilled services to the claim; Submit the claim as noncovered, if appropriate; or Append the new condition code,” CMS instructs. “These actions will prevent unnecessary reviews and denials for the HHA and allow Medicare to better target medical review resources.”
See the article at www.cms.gov/Outreachand-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9474.pdf.
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