Home Health & Hospice Week

Regional home health intermediaries appear to be coming around to an easier way of billing for therapy when it unexpectedly exceeds the 10-visit threshold under the prospective payment system.

If agencies have submitted a request for anticipated payment but no final bill, they must cancel the RAP, submit a new one with the therapy upgrade, and continue normally, RHHI Palmetto GBA says in a March 3 question-and-answer document with its 12-state home health coalition. "Canceling the RAP is necessary ... because Medicare systems require the earliest dated HIPPS code on a claim to match the HIPPS code submitted on the RAP," the Centers for Medicare & Medicaid Services explains in a clarification to Palmetto.

If the claim already has been paid, then an HHA simply can submit an adjustment claim to change the HIPPS code, says the Q&A, posted to Palmetto's Web site late last month. Rebilling at the higher therapy rate gains about $2,000 per episode.

These instructions confirm that HHAs won't need to file a significant change in condition when they unexpectedly provide more than 10 therapy visits to a patient, says Lynn Olson with Corpus Christi, TX-based billing company Astrid Medical Services. "It's much easier" to adjust or cancel and rebill claims "than to deal with SCICs," Olson judges. When only a RAP has been submitted, "you can just do a clean new episode," he cheers.

CMS notes that not all RHHIs shared "this understanding" when first contacted, but by now they should be clued in.

Agencies shouldn't forget about their OASIS obligations when therapy changes, reminds consultant Pat Sevast with American Express Tax & Business Services in Timonium, MD. CMS tells providers to make a note in the patient's record of the change and to correct MO825 on the original OASIS assessment, Palmetto notes. "Agencies can make this non-key field change to their files and retransmit the corrected assessment," CMS says.

Other topics covered in the Q&A include: