Home Health & Hospice Week

For home health agencies furnishing Part B outpatient therapy services in the home, don’t be surprised to see denials if you leave Functional Reporting G codes off your claims.

Background: "The Functional Reporting data collection system is effective for therapy services with a Date of Service (DOS) on or after January 1, 2013," the Centers for Medicare & Medicaid Services notes in MLN Matters article SE1307. "However, a testing period was in effect from January 1, 2013, through June 30, 2013, to allow providers to use the new coding requirements without penalty while they assured that their systems worked. During this period, claims were processed with or without the required G-codes and modifiers."

Now the claims system is requiring the reporting, under which providers must use 42 G codes and seven severity/complexity modifiers.

If you fail to include the required codes, "Medicare will return a Claim Adjustment Reason Code 246 (This non-payable code is for required reporting only.) and a Group Code of CO (Con-tractual Obligation) assigning financial liability to the provider," CMS explains. "In addition, beneficiaries will be informed via Medicare Summary Notice 36.7 that they are not responsible for any charge amount associated with one of these G-codes."

More details about the requirement are in the article at www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE1307.pdf.