Medicare Compliance & Reimbursement

CMS promises fix soon.

Thanks to a technical glitch, many home health agencies will have to wait a while longer before seeing the 5-percent rural add-on they are entitled to.

That's because the Centers for Medicare & Medicaid Services home health payment software isn't set up to recognize all the counties the new Core Based Statistical Area wage index designates as rural.

CMS issued a recent instruction implementing the Deficit Reduction Act payment rate changes for HHAs, including the add-on for services furnished in rural areas. The rural add-on applies to "CBSA codes that begin with '999,'" CMS notes in the transmittal.

The problem lies in the fact that HHAs are undergoing a one-year transition blending the old Metropolitan Statistical Area wage index designations and the new CBSA designations; as a result, many counties that qualify as rural are using a blended code that doesn't begin with 999. While the old criteria "identifies rural areas for many states, it overlooks that certain rural areas were affected by the implementation of our blended wage index," a CMS official acknowledges in a recent Open Door Forum for home health providers.

For example, in Texas there were so many wage index changes that every single rural county is using a blended code instead of a 999 code, says Heather Vasek with the Texas Association for Home Care. Thus, "none of our providers are getting a rural add-on at this point," she tells Eli.

"Some home health agencies have been underpaid because of the transition code problems," the National Association for Home Care & Hospice notes.

The solution is in progress, however. CMS is updating and testing the claims payment software to include the rural blended codes, the CMS staffer said in the forum. "There's quite a long list of the blend codes that are affected ... between two and five codes per state in 22 states." CMS plans to issue its instruction in the first week of March with a deadline for intermediaries to start paying rural add-ons correctly by March 13, the CMS official explains. And providers won't need to take any additional action -- intermediaries will reprocess the underpaid claims automatically.

The fact that providers won't have to take any additional action to claim their add-ons is good news, Vasek says.