Home Health & Hospice Week

Tip: Include only one Q code line per claim.

The month after Medicare started requiring home health agencies to use site of service codes on their final claims, many agencies hadn’t mastered the new requirement.

So says HHH Medicare Administrative Contractor CGS in a message to providers. August 2013 claim submission error data indicated "a high volume of claims going to the Return to Provider (RTP) status/location (T B9997) for reason code 31790," CGS explains. "This reason code indicates the home health claim does not include the HCPCS code Q5001, Q5002, or Q5009."

Reminder: Starting in July, HHAs had to start using Q5001 (Hospice or home health care provided in patient’s home/residence); Q5002 (…in assisted living facility); or Q5009 (…in place not otherwise specified) to indicate where they furnish services (see Eli’s HCW, Vol. XXII, No. 13). "The location where services were provided should be reported along with the first billable visit in a HH PPS episode," the Centers for Medicare & Medi-caid Services instructed in revised MLN Matters article MM8136. "In addition to reporting a service line according to current instructions, HHAs must 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."

And, "if the location where services were provided changes during the episode, the new location should be reported with an additional line corresponding to the first visit provided in the new location," CMS continues in the MLN Matters article.

Important: CGS offers tips to avoid the returned claims. "Report the HCPCS code only once on a claim unless the location changes," the MAC says. It should be a separate line item.

When the location does change, "report a new line item with the appropriate HCPCS code along with the 1st visit provided in the new location," the MAC instructs.