Home Health & Hospice Week

Are you reporting the right point of origin code?

Question: What steps do I need to follow when admitting a patient transferring from another home health agency?

Answer: Transfers are a tricky area, and can often lead to disputes with the transferring agency.

Documenting the measures you took may save your reimbursement if you must resort to your HHH Medicare Administrative Contractor to resolve the issue.

Follow this guidance from Palmetto GBA on the procedure you should follow when admitting a transfer patient:

• Check the Health Insurance Query (HIQH) for HHAs to determine if the beneficiary is currently under an established plan of care with another HHA. A patient status of 30 indicates that the patient is currently under an established plan of care. Therefore, regardless of whether the receiving agency is admitting a patient outside of the episode currently reflected in HIQH, the transfer requirements apply.
• Document in the record that you accessed HIQH by printing and stamping page three in HIQH.
• When the patient is under the care of another HHA, contact the initial HHA to work out the transfer date.
• Document you contacted the other agency and include who you talked to at the agency, date contacted, and time contacted.
• Inform the beneficiary that the initial HHA will no longer receive Medicare payment on behalf of the patient and therefore, will no longer provide Medicare-covered services to the patient after the date of the patient’s elected transfer.
• Document in the patient’s file that the beneficiary was notified of the transfer criteria and the possible payment implications.

Plus: The National Uniform Billing Committee retired point of origin codes ‘B’ and ‘C’ effective for claims with dates of service on or after July 1, 2010, Palmetto notes in its transfer job aid. So now agencies must report condition code 47 (FL 18-28) when admitting a Medicare patient to your agency as a transfer from another HHA, the MAC instructs.

However, you do need to report a point of origin code in (FL-15) on the UB-04 (CMS-1450) form, Palmetto points out. “This field must represent a place rather than a referral source,” the MAC says.

Note: For a list of point of origin codes and other transfer billing tips, see Palmetto’s job aid by going to www.palmettogba.com, clicking on “Jurisdiction M Home Health & Hospice,” then selecting “Learning” from the “Topics” drop-down menu, then clicking on “Job Aids,” then scrolling down to the “Home Health Transfers: Key Points” link.