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Home Health & Hospice Week

Supplies:

KNOW THE INS AND OUTS OF NRS REIMBURSEMENT

Published on Mon Oct 08, 2007

This knowledge will be crucial to avoiding payment delays in 2008.

The new supplies reimbursement methodology in the prospective payment system refinements is complicated, but you have a few extra months to get the hang of it before penalties begin.

The Centers for Medicare & Medicaid Services will begin informational nonroutine supplies (NRS) edits next April--that means you'll get a warning message, but no claims payment holdups. The agency will end the grace period and start returning claims for NRS problems in October, it says in a Nov. 2 transmittal.

Why it matters now: You need to have a basic understanding of NRS reimbursement when PPS hits Jan. 1. NRS payments could mean as much as a $551 difference to your episode amount starting then.

How NRS case mix works: Points from 11 OASIS items make up the NRS point total for the case mix system. The point total puts the episode into one of six severity categories.

The fifth digit of the HIPPS code will represent the NRS level. But it's not just a straightforward NRS level indicator.

The code uses a set of letters (S-X) for NRS severity levels when the billing agency does furnish supplies and a set of numbers (1-6) for when the HHA does not furnish them.

CMS will use the dual set of NRS indicators to return to provider (RTP) claims that don't include required supplies line items. So claims that have a HIPPS code ending in a letter will be subject to the NRS edits and possible claims delays, while claims with a HIPPS code that ends in a number will not, explains the transmittal.

Supplies codes: HHAs can use revenue code 0027 to record their supplies charges. And they can opt for revenue code 0623 to report wound care supplies separately, CMS notes in the transmittal.

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