Home Health & Hospice Week

Starting in April, your claims will have to jump a few more hurdles on the diagnosis coding front.

“The HH Grouper program has various data validity edits that make sure it uses consistent and accurate data when calculating payment groups on HH claims,” the Centers for Medicare & Medicaid Services explains in MedLearn Matters Article MM12924.

Old way: “Of these edits, currently only a principal diagnosis not assigned to a clinical group causes HH claims to be returned to the provider. Other principal diagnosis code errors aren’t returned to the provider,” CMS explains. “In some cases, this causes processing problems.”

New way: “New edits will identify various error con­ditions helpful to providers in improving claims accuracy,” CMS says. “If the diagnosis coding issues are identified, we return the claim to the provider for correction.”

See a list of diagnosis code-related returned claim messages at www.cms.gov/files/document/mm12924-home-health-claims-new-grouper-edits.pdf. Note: “Primary diagnosis identified as a code first code with condition present” is no longer on the list, CMS points out in the revised article.