Wiki HOME HEALTH in ASSISTED LIVING - Any Home Health Coders out there?

[1formissy]

I did not see a subject specifically for Home Health questions. I am trying to locate information regarding CMS guidelines in regards to a Home Health Agency rendering services to a patient who is a resident of a assisted living facility, and requires that of a skilled nurse for wound care.
The assisted living facility has a RN on site, but the Home Health Agency would like to have their SN see the patient for the wound care. Does anyone know of guidelines that identifies this particular situation?
Please do not refer me to the CMS manuals, as I am very familiar with them, and have read Chp 7 and 10 more than one. Sorry, I do not mean to sound harsh, I just really need a answer, if anyone knows.

 

[1formissy]

I found the answers I needed.

 

[kengle0212]

Home Health Medicare Remittance Advice- Forward Balance

I need help with understanding forwarding balance. I am new to Home Health. The individuals are telling me that remittances are different for HH for example.

My remit shows we billed 800 of charges. Medicare allowed 1300. There was a line adj of -1300. Total payment to us 0.

At the bottom the Forward balance says -1300.

Now these ladies in billing are telling me that the FB amount is a payment.

I am lost please help.

 

[1formissy]

I need help with understanding forwarding balance. I am new to Home Health. The individuals are telling me that remittances are different for HH for example.

My remit shows we billed 800 of charges. Medicare allowed 1300. There was a line adj of -1300. Total payment to us 0.

At the bottom the Forward balance says -1300.

Now these ladies in billing are telling me that the FB amount is a payment.

I am lost please help.

______________

Sorry you are having trouble. I am also sorry that I can provide no help. We are waiting to go through survey to get our PTAN for Medicare so I have not even billed Medicare yet. I have not even seen a Home Health Remittance Advice yet. I do know that if you review the information on CMS.gov in regards to RAP Payments for Home Health, they can provide you some insight on how they pay for Home Health. I know I am not that helpful, and I apologize. I will be facing those same challenges here in the next month or so!

 

[1formissy]

I need help with understanding forwarding balance. I am new to Home Health. The individuals are telling me that remittances are different for HH for example.

My remit shows we billed 800 of charges. Medicare allowed 1300. There was a line adj of -1300. Total payment to us 0.

At the bottom the Forward balance says -1300.

Now these ladies in billing are telling me that the FB amount is a payment.

I am lost please help.

____________________________
Sorry, I did not address your question on Forwarding Balance. A forwarding balance on a remittance advice means a payment that was previously made to a claim has been recouped. (Due to an overpayment). So that amount you are talking about, $-1300 is actually a recoupment. You should contact your MAC and see where they are taking the money from if it does not have an ICN on that remittance.

 

[1formissy]

I need help with understanding forwarding balance. I am new to Home Health. The individuals are telling me that remittances are different for HH for example.

My remit shows we billed 800 of charges. Medicare allowed 1300. There was a line adj of -1300. Total payment to us 0.

At the bottom the Forward balance says -1300.

Now these ladies in billing are telling me that the FB amount is a payment.

I am lost please help.

You may want to study up on RAP payments because it looks like that is what happened with your scenario. When the RAP payment is received, and you submit a final claim, CMS will recoup the RAP and then submit a payment for the entire episode of Home Health.