Medicare Compliance & Reimbursement

Changing codes could cause reimbursement snags.

Many home health care providers are confused about whether they received correct payments because they don't have updated wage index information, says billing consultant Rose Kimball with Med-Care Administrative Services in Dallas. The Centers for Medicare & Medicaid Services doesn't notify providers when their county changes from rural to urban status or vice versa. "They have to find out on their own," she points out.

And providers are already perplexed by all the Deficit Reduction Act-mandated changes that have resulted in held claims, overpayments and underpayments. "Many providers are so confused about the nature of these issues that ... they may not be able to identify whether or not their claims are paying correctly," notes consultant M. Aaron Little with BKD in Springfield, MO.

Experts recommend that billers follow these tips to make sure they get every penny they're entitled to:

• Confirm codes. HHAs should double-check that they are using the correct wage index code and that the area is still in the designation it used to be in -- rural or urban, Kimball advises.

• Audit payments. "HHAs need to be checking for all services done and paid after Jan. 1 to ensure the proper payment is being made," urges consultant Tom Boyd with Boyd & Nicholas in Rohnert Park, CA. "Mistakes will be made in the revised coding resulting from the CBSAs and wage index changes."

"Agencies will need to establish audit processes to ensure that the eventual corrective action fully identifies all claims where additional rural add-on payment is due," the National Association for Home Care & Hospice adds.

• Bill correctly. Once CMS issues the list of blended codes eligible for the rural add-on, check your codes to make sure they are on the list if you think they should be, Little recommends to HHAs. Then, make sure your software vendor updates your software so you "have something to compare against to determine whether ... claims have been correctly paid."

A word of caution: Make sure your software is billing the rural add-on for episodes beginning after Jan. 1, not ending after that date, Little urges. Unlike previous years, the add-on applies to when the episode starts.