Home Health & Hospice Week

Plus: Revised OASIS-C should be unveiled soon.

Medicare is making a claim format change to simplify processing.

The Centers for Medicare & Medicaid Services is scrapping the "33x" type of bill for home health agencies as of Oct. 1, CMS’s Wil Gehne pointed out in the May 8 Open Door Forum. It will keep the 32x TOB. "As part of the ongoing effort to simplify codesets and to make sure that codes are less payor-specific and more for general use by all payors, the National Uniform Billing Committee looked at those two types of bill and decided they are no longer needed," he said.

Most HHAs should be billing only on 32x claims anyway, Gehne added. Since 2000, CMS has instructed agencies to bill under the 32x format and let the claims system change the type of bill when required. The different formats correspond to whether the Part A or Part B Medicare trust fund is paying the claim.

Change: Providers may notice that "they won’t see any claims that are changed from the 32x type of bill that they submitted to the 33x on their remittance advices anymore," Gehne explains. If HHAs submit a 33x TOB in error, the system will return it for correction.

CR 8244 outlining the change will be available at www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2013-Transmittals.html.

Add These Therapy Codes To The Bundled List

In another billing change, CMS has added two codes for negative pressure wound therapy, G0456 and G0457, to the home health consolidated billing list. The bundling list has contained two codes for NPWT since 2005, Gehne said. "These are further specifications of those same services."

Clarification: When Part B therapy provid-ers furnish these codes, the Medicare claims system will deny the claims, Gehne explained. HHAs and the therapy provider then must work out how, if at all, the agency will reimburse the therapy provider for the service. But if bundled codes are billed by a physician’s office, the edits do not apply, Gehne said.

The related CR is at www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R2672CP.pdf and takes effect July 1.

Plus: Gehne reminded listeners of the re-quirement to report site of service Q codes starting July 1 (see Eli’s HCW, Vol. XXII, No. 13). Starting in July, HHAs must use Q5001 (Hospice or home health care provided in patient’s home/resi-dence); Q5002 (…in assisted living facility); or Q5009 (…in place not otherwise specified) to indicate where they furnish services.

Don’t let the new reporting mechanism confuse you. "The location where services were provided should be reported along with the first billable visit in a HH PPS episode," CMS instructs in revised MLN Matters article MM8136. "In addition to reporting a service line according to current instructions, HHAs must report an additional line item with the same revenue code and date of service, reporting one of the three Q codes (Q5001, Q5002, and Q5009), one unit, and a nominal charge (e.g., a penny)."

Wrinkle: "If the location where services were provided changes during the episode, the new location should be reported with an additional line corresponding to the first visit provided in the new location," CMS says in the MLN Matters article.

For episodes beginning on or after July 1, claims will be returned if they lack a Q code line and if that line doesn’t correspond to the earliest home health visit, CMS cautions. HHAs will also see claims returned when more than one line on an HH PPS claim reports Q5001, Q5002, or Q5009 and the same HCPCS code is reported on consecutive dates, CMS adds.

Other HHA topics addressed in the Open Door Forum include:

• OASIS-C update. The next set of revisions to OASIS-C are scheduled to take effect in October 2014, when ICD-10 diagnosis coding changes also begin. But CMS hopes to reveal the assessment tool changes much sooner than that.

CMS has submitted the updated version of OASIS-C and is waiting for it to be posted on the Paperwork Reduction Act package website. "We would like it to be any day now," said CMS’s Robin Dowell.

Until the new OASIS-C incarnation does take effect in 17 months, HHAs can download a newly Office of Management and Budget-ap-proved form for current OASIS-C, Dowell noted in the forum. The last form contained a July 31, 2012 expiration date but was still in effect until OMB approved the new form (which had no updates). The new form has an expiration date of Dec. 31, 2014 and is online at www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/OASISC.html in the "Down-loads" section.

• OASIS training. Use CMS’s new educational tools to help get your staff up to speed on OASIS requirements. CMS recently posted new surveyor training modules on a range of topics including ADLs, therapy needs, and care management, noted CMS’s Pat Sevast in the forum. "Use these modules for training new staff and remedial training of existing staff who need information related to the OASIS items," Sevast recommended in the forum.

The training modules are at http://surveyortraining.cms.hhs.gov/index.aspx — click on "I Am A Provider," then "Web-Based Training," then "Outcome and Assessment Information Set (OASIS) Training (OASIS)," then "Launch the Course" to see the 15 training modules offered.

• HHCAHPS. Don’t be surprised if you don’t see your satisfaction survey data posted on Home Health Compare yet, said CMS’s Lori Teich-man in the forum. CMS doesn’t post Home Health Consumer Assessment of Healthcare Providers and Systems data on HH Compare until the agency has four quarters of CAHPS data reported.

HHAs can also access some new resources on the HHCAHPS website — documents on patient mix adjustment and HHA responsibilities under the program.