Industry Notes:
Straighten Out Your Payment Diagnosis Code Questions With New Instructions
Published on Thu Jan 22, 2004
M0245 codes won't show up on the claim, manual revisions explain.
Months after M0245 was introduced, the new OASIS item continues to cause billing confusion among home health agencies. But a new transmittal from the Centers for Medicare & Medicaid Services may clear up questions and ensure HHAs get their rightful payment under the prospective payment system. HHAs must follow ICD-9 coding conventions when assigning a patient's primary diagnosis, thanks to the Health Insurance Portability and Accountability Act (HIPAA). And the primary diagnosis must match on both OASIS and the claim submitted to Medicare, according to Jan. 16 Transmittal No. 61 - a revision to the Internet Only Manual (IOM) on Medicare Claims Processing (Pub. 100-04). IOMs replaced the HIM 11 last fall. But there is no such matching requirement for the diagnosis codes that go into M0245, CMS notes. "The codes reported in M0245a and M0245b may not appear on the claim form at all," explains the transmittal at http://cms.hhs.gov/manuals/pm_trans/R61CP.pdf. CMS added M0245 to OASIS when HIPAA required agencies to report a non-paying diagnosis V code in M0230, bumping a payment diagnosis code. HHAs can put that bumped payment diagnosis code in M0245 and still capture the associated reimbursement for the condition (see Eli's HCW, Vol. XII, No. 13, p. 101). Home care was one of the areas with greatest spending increases in 2002, according to the Maryland Health Care Commission. Home care spending for Maryland residents increased 20 percent over the previous year, the Associated Press reports. Health care spending for residents overall grew 11 percent in the time period. For-profit hospice chain Odyssey Health-Care Inc. has made the largest acquisition in its history. The Dallas-based publicly traded company acquired Crown of Texas Hospice, Amarillo, Ltd. and Crown of Texas Hospice, Southeast, Ltd. effective Jan. 15. The Crown hospices serve about 400 patients in 29 counties in the Texas panhandle and north of Houston, Odyssey says in a release. Odyssey paid $22.5 million in cash for the hospices, which will continue to operate as separate programs from other company locations in the state. "While this acquisition is the largest in our history, our focus will remain on organic growth," Odyssey President and CEO David Gasmire says in the release. The acquisition brings Odyssey up to 68 locations in 29 states. Odyssey currently is the largest publicly traded hospice company, although an initial public offering from VITAS Healthcare Corp. after its sale may change Odyssey's status (see Eli's HCW, Vol. XIII, No. 1, p. 5). Operation Wheeler Dealer is taking its toll on the biggest as well as the smallest suppliers. The Scooter Store in New Braunfels, TX is cutting 200 jobs thanks to the recent "clarification" on wheelchair [...]
