Home Health & Hospice Week

CMS promises fix soon.

Thanks to a technical glitch, many home health agencies will have to wait a while longer before seeing the 5 percent rural add-on they are entitled to.

That's because the Centers for Medicare & Medicaid Services home health payment software isn't set up to recognize all the counties designated as rural under the new Core Based Statistical Area (CBSA) wage index designations.

CMS issued a Feb. 10 instruction implementing the Deficit Reduction Act payment rate changes for HHAs, including the add-on for services furnished in rural areas. The rural add-on applies to "CBSA codes that begin with '999,'" CMS noted in the transmittal.

The problem: However, HHAs are undergoing a one-year transition blending the old Metropolitan Statistical Area (MSA) wage index designations and the new CBSA designations, so many counties that qualify as rural are using a blended code that doesn't begin with 999. While the old criteria "identifies rural areas for many states, it overlooks that certain rural areas were affected by the implementation of our blended wage index," a CMS official acknowledged in the Feb. 28 Open Door Forum for home health providers.

For example, in Texas, there were so many wage index changes that every single rural county is using a blended instead of a 999 code, says Heather Vasek with the Texas Association for Home Care. Thus, "none of our providers are getting a rural add-on at this point," Vasek tells Eli.

"Some home health agencies have been underpaid because of the transition code problems," the National Association for Home Care & Hospice notes.

The solution: CMS is updating and testing the claims payment software to include the rural blended codes, the CMS staffer said in the forum. "There's quite a long list of the blend codes that are affected ... between two and five codes per state in 22 states."

CMS plans to issue its instruction in the first week of March with a deadline for intermediaries to start paying rural add-ons correctly by March 13, the CMS official said. And providers won't need to take any additional action--intermediaries will reprocess the underpaid claims automatically.

The fact that providers won't have to take any additional action to claim their add-ons is good news, Vasek says.

3 Steps To Secure Your Rightful Payment

Many providers are confused about whether they've been paid correctly because they don't have updated wage index information, says billing consultant Rose Kimball with Med-Care Administrative Services in Dallas. CMS doesn't notify providers when their county changes from rural to urban status or vice versa. "They have to find out on their own," Kimball points out.

And providers are already perplexed by all the DRA-mandated changes that have resulted in held claims, overpayments and underpayments. "Many providers are so confused about the nature of these issues that ... they may not be able to identify whether or not their claims are paying correctly," notes consultant M. Aaron Little with BKD in Springfield, MO.

Follow these experts' tips to make sure you're getting every penny you're entitled to:

• Confirm codes. Double-check that you are using the correct wage index code and that the area is still in the designation it used to be in--rural or urban, Kimball advises.

• Audit payments. "HHAs need to be checking for all services done and paid after Jan. 1 to ensure the proper payment is being made," urges consultant Tom Boyd with Boyd & Nicholas in Rohnert Park, CA. "Mistakes will be made in the revised coding resulting from the CBSAs and wage index changes."

"Agencies will need to establish audit processes to ensure that the eventual corrective action fully identifies all claims where additional rural add-on payment is due," NAHC says.

• Bill correctly. Once CMS issues the list of blended codes eligible for the rural add-on, check your codes to make sure they are on the list if you think they should be, Little recommends. Then, make sure your software vendor updates your software so you "have something to compare against to determine whether ... claims have been correctly paid."

Caution: Make sure your software is billing the rural add-on for episodes beginning after Jan. 1, not ending after that date, Little urges. Unlike previous years, the add-on applies to when the episode starts.