Home Health & Hospice Week

New NRS edits to hit next month, CMS warns in forum.

The honeymoon period for getting used to nonroutine supplies reporting is nearly over.

The Centers for Medicare & Medicaid Services will put claims system edits in place next month that will focus on NRS.

“After April 7, if a final claim … reports a HIPPS code that states supplies were provided, Medi-care systems will check to see that at least one supply revenue code is on the claim,” CMS’ Wil Gehne ex-plained in the Feb. 20 home health Open Door Forum.

How it will work: The fifth digit of the HIPPS code indicates whether the agency furnished NRS in the episode. A number indicates no supplies were furnished, so the claim won’t have to have an NRS revenue line. A letter indicates the agency did furnish supplies, so at least one revenue line must be present.

But agencies will get a learning period with the new edit. From April 7 to Sept. 30, the claim will still pay even if it gets caught in the edit. The agency will merely receive a set of remark codes indicating the claim is out of compliance with the NRS requirement (see Eli’s HCW, Vol. XVI, No. 39).

Starting Oct. 1, the system will return to provider (RTP) such claims, Gehne reminded attendees. Providers then must either change the HIPPS code or add an NRS line item to the claim, then resubmit.

The informational edit grace period gives agencies “an opportunity to develop processes that correct [NRS problems],” Gehne said.

Many providers have asked what revenue codes they are supposed to use for NRS, Gehne said. Those requirements haven’t changed since PPS’ inception, he noted. “There are just the two revenue codes that supplies are reportable under.”

Only two codes: Agencies should use code 027X for general NRS and code 062X for wound care supplies, the Medicare Claims Processing Manual instructs in Chapter 10, Section 40.2.

HHAs don’t have to list each supply separately, Gehne explained. Home health PPS claims don’t require HCPCS codes for each supply type.

Don’t forget: HHAs don’t need to report routine supplies on claims, Gehne said. Those are bundled into PPS rates. Separate line items should list NRS only.

Agencies also should list their customary supplies charges--including a markup--on the claim, advises consultant and accountant M. Aaron Little with BKD in Springfield, MO (see Eli’s HCW, Vol. XVII, No. 7).

No match: PPS systems no longer require all five digits in the HIPPS code to match from RAP to final claim, Gehne told the forum. CMS lifted the matching requirement for the fifth digit so agencies can change the supplies indicator when necessary.

Note: A link to the Medicare Claims Processing Manual (100-04) is at www.cms.hhs.gov/Manuals/IOM/list.asp.