Advanced Search

Home Health & Hospice Week

Reimbursement:

Know Your Facts - M0175 Recoupments

Published on Sat Aug 07, 2004

Home health agencies are getting a bit of breathing room on coming M0175 takebacks.
 
While the recoupments related to the OASIS item on prior inpatients stays originally were scheduled for this summer, the Centers for Medicare & Medicaid Services has pushed them back to January 2005, CMS indicates in a recent program transmittal. And now the recoupments will be offset at least partially by the money Medicare owes agencies for unreported skilled nursing facility and rehab stays.
 
Intermediaries will give agencies five weeks notice when they are about to make the retroactive recoupments (or refunds), CMS says in the transmittal. That will give HHAs time to look over and verify the accuracy of the adjustments.
 
CMS won't make the M0175 adjustments for the first three years of the prospective payment system simultaneously, it pledges. In fact, CMS will take almost two years to implement the recoupments or refunds, reports the National Association for Home Care & Hospice. The gradual implantation "should moderate the cash flow impact for affected agencies," NAHC says.
 
M0175 adjustments will be identified on the remittance advice by type of bill 3xI and remark code N180, CMS explains.
 
Separately, ongoing edits currently downcode claims when hospital stays aren't reported. Those pre-pay edits function separately from the annual post-pay takebacks (see Eli's HCW, Vol. XII, No. 39, p. 306).

Other Articles in this issue of

Home Health & Hospice Week

View All