Home Health & Hospice Week

Try this keying trick to get them through.

Get up to speed on the new claims requirement for county codes, before your cash flow gets seriously backed up.

Reminder: “On all Requests for Anticipated Payments (RAPs) and home health claims (type of bill 032X) with dates of service on or after January 1, 2019, providers must report [new value code] 85 and the Federal Information Processing Standards (FIPS) State and County Code,” HHH Medicare Administrative Contractor CGS reminds home health agencies in a Jan. 10 website post.

As of Jan. 7, the Medicare claims system is returning claims that don’t contain both the value code and a valid FIPS state/county code.

Important: All HHAs must report the VC and county code, not just those that receive a rural add-on bonus.

You can tell whether this is the reason for your returned claim by looking at the reason code. “If the VC 85 and FIPS State and County Code are invalid or are missing from the billing transactions (RAP or claim), they will be moved to the Return to Provider (RTP) file (T B9997) with reason code 37257 for providers to correct,” CGS explains.

The new VC and requirement are part of the methodology for implementing the five-year phase out of the home health rural add-on, enacted in the Bipartisan Budget Act last February 2018 (see Eli’s HCW, Vol. XXVII, No. 42). MACs will “apply rural payment rates based on whether the FIPS State and County Code is in the list of codes associated with one of three categories of rural counties,” the Centers for Medicare & Medicaid Services says in an updated MLN Matters article on the topic. Three categories of rural counties will receive differing levels of add-on payments.

Tip: If you think you have been submitting the VC and state/county code but still are seeing returns, check how you are entering the state/county code. “When entering the FIPS State and County Code, the number would be keyed, followed by two zeros. For example, 19153 would be keyed as 1915300 or 19153.00,” CGS instructs.

In the MLN Matters article and related transmittal, both updated Dec. 31, 2018, CMS provides a new link to a list of the state/county codes: www.census.gov/geographies/reference-files/2017/demo/popest/2017-fips.html.