Home Health & Hospice Week

Don't miss this crucial billing deadline. 

Would you like to receive an extra $1,800 to $2,200 for services you've already provided? You have one last chance to claim the therapy dollars you may have missed.

Home health agencies have until Dec. 31, 2003 to fix claims for episodes from October 2001 to December 2002, explains Diane McKinney with the home health team of the accounting firm Abraham & Gaffney in St. Johns, MI. And one error you should especially try to fix is underpayments for episodes in which you provided 10 or more therapy visits, she says.

"Most agencies have at least one underpaid therapy claim; we've found agencies receiving from $2,000 to $250,000 less than they should have," McKinney reports.

If you predict 10 or more therapy visits by answering "yes" to M0825, but then provide fewer than 10 therapy visits, the fiscal intermediary automatically will downcode the claim to reflect the fact that you didn't meet the high-therapy threshold.

But the reverse is not true. If you predict fewer than 10 therapy visits by answering "no" to M0825 but provide 10 or more therapy visits, the FI won't automatically pay you the extra money due to you. You'll need to correct the RAP or final claim to get paid.

To correct the final claim, you must cancel the original RAP, submit the corrected RAP, cancel the original final claim and then submit the new claim, explains Lynn Olson with Corpus Christi, TX-based Astrid Medical Services. The downside to that approach is that the intermediary will "take back the money" for the original RAP and claim, and you will need to wait for the system to pay the revised claims, Olson cautions.

And don't send the claims in all at once, he says. Allow a few days between each step so one is processed before the next arrives.

Incorrect estimates are not uncommon, says consultant Terry Cichon with Deerfield, IL-based FR&R Healthcare Consulting. Remember, physical, occupational and speech therapy - including therapy assistants' visits - count toward the high-therapy threshold.

To find out if the government owes you money, audit claims in which you made 10 or more therapy visits but answered "no" to M0825, McKinney advises. Only claims from October 2001 on can be corrected now.

Even if you answered "yes" to M0825 and made 10 or more therapy visits, you could still have lost about $2,000 you earned. This would occur if you submitted the claim without listing 10 therapy visits on the UB 92, Cichon says.

This might happen if you employ contract therapists and haven't received one or more visit notes before you file the final bill, she adds. Look at all therapy downcodes you received since October 2001 to discover claims with this error, Cichon advises.

As with any question affecting reimbursement, document, document, document. It's very likely that intermediaries will ask for additional documentation for these claims, she warned.