CMS Updates Home Health Claim Processing Instructions for Unsolicited Responses

The Centers for Medicare & Medicaid Services (CMS) recently updated the claims processing instructions for Medicare Administrative Contractors (MACs), including instructions for processing multiple unsolicited responses on the same home health claim. Prior to the implementation of PDGM (Patient Driven Groupings Model), there was no need for multiple unsolicited responses to be processed during the…

Recommendations and Clarifications for HHAs on the No-Pay RAP

Beginning January 1, 2021, home health agencies (HHAs) will be required to submit a request for anticipated payment (RAP) that will be paid at 0 percent, prior to each claim. The Centers for Medicare & Medicaid Services (CMS) finalized the No-pay RAP policy in the CY 2020 Home Health Prospective Payment System Rate Update rule.…

Attention Billers: Medicare Secondary Payer Problem With HETS

The Centers for Medicare & Medicaid Services (CMS) and the Medicare Administrative Contractors (MACs) are aware of a problem with the HIPAA Eligibility Transaction System (HETS) Medicare Secondary Payer (MSP) data received from the Common Working File (CWF).  The MACs’ eligibility systems/portals that receive MSP data from HETS may be affected by this issue. Due…

CMS to Shutter Common Working File for Eligibility Queries Effective February 1, 2020

The Centers for Medicare & Medicaid Services (CMS) has been working over recent years to migrate queries related to benefit eligibility from the Common Working File (CWF) and to establish the HIPAA Eligibility Transaction System (HETS) as the single source for beneficiary eligibility transactions.  The National Association for Home Care & Hospice (NAHC) has been…

Movement to HETS as Sole Source for Eligibility Queries on Horizon

CWF: 3rd and later hospice benefit periods not calculating correctly In recent years, the Centers for Medicare & Medicaid Services (CMS) has taken steps to transition providers away from direct queries to the Common Working File (CWF) and toward the HIPAA Eligibility Transaction System (HETS) as the single source for beneficiary eligibility transactions.  Earlier this…

CMS Proposes to Require a Notice of Admission

The Centers for Medicare & Medicaid Services (CMS) is proposing to eliminate the advance, split percentage payments for all home health agencies (HHAs) in 2021. Therefore, agencies will no longer submit Requests for Anticipated Payment (RAPs) beginning January 1, 2021. The RAP submission opens a home health prospective payment system (HHPPS) episode in the CMS…

Office of Inspector General Adds New Items to Home Health Work Plan

The Office of Inspector General (OIG) work planning  is dynamic and adjustments are made throughout the year to meet priorities and to anticipate and respond to emerging issues. A Work Plan was developed and is available to the public.  It is updated monthly with new issues.  In January 2019, there are two new issues of…

New Edit for Hospice Medicare Claim Processing

The Centers for Medicare & Medicaid Services (CMS) released Change Request (CR) 11049/Transmittal 4187, Ensuring Only the Active Billing Hospice Can Submit a Revocation, which implements a new edit for hospice claims received on or after July 1, 2019.  Currently, the Common Working File (CWF) will allow Notices of Revocation/Termination (NOTR – Type of Bill…

CMS Further Modifies Processes Related to Redesign of Hospice Periods in CWF

Earlier this year the Centers for Medicare & Medicaid Services (CMS) issued a MLN Matters Article (SE 18007 – Recent and Upcoming Improvements in Hospice Billing and Claims Processing) that announced significant changes to the way hospice periods are configured in the Common Working File (CWF).  MLN SE 18007 also announced improvements to the way…