Home Health & Hospice Week

Pay rate will be higher for initial visit.

The new home infusion therapy services benefit is coming more in focus, thanks to a new Medicare transmittal.

The Centers for Medicare & Medicaid Services is-sued CR 11880 on Aug. 7, outlining “guidance and claims processing systems changes” for the HIT benefit that will take effect Jan. 1.

Reminder: “The Medicare HIT services benefit covers the professional services, including nursing services, furnished in accordance with the plan of care, patient training and education (not otherwise covered under the durable medical equipment benefit), remote monitoring, and monitoring services for the provision of home infusion drugs furnished by a qualified HIT supplier,” CMS explains in an accompanying MLN Matters article.

“Home health agencies, concurrently enrolled as qualified HIT suppliers, will need to continue submitting a standard 837/CMS-1450 institutional claims form for the professional home health services to the A/B MAC (HHH) and a separate 837P/CMS-1500 professional and supplier claims form for the professional HIT services to the A/B MAC,” CMS instructs.

And “because the HIT services are contingent upon a home infusion drug J-code being billed, the appropriate drug associated with the visit must be billed with the visit or no more than 30 days prior to the visit,” CMS continues.

New feature: “Medicare is increasing the payment amounts for each of the three payment categories for the initial infusion therapy service visit by the relative payment for a new patient rate over an existing patient rate using the physician evaluation and management (E/M) payment amounts for a given year,” CMS says in the article. “Overall, this adjustment would be budget-neutral, resulting in a small decrease to the payment amounts for any subsequent infusion therapy service visits.”

In other words, the pay rate for a patient’s first visit will go up, while the rates for subsequent visits will go down.

The six G codes for HIT services are in the transmittal at www.cms.gov/files/document/r10269cp.pdf and the article at www.cms.gov/files/document/mm11880.pdf.