CMS Issues Additional Home Health Claim Processing Instructions

The Centers for Medicare & Medicaid Services (CMS) has issued Change Request 12424 that provides additional instructions related claims processing for the notice of admission (NOA) for claims that span calendar years 2021 and 2022, and special circumstances for discharges when no visits are made in a subsequent 30 day period. In the Medicare Claims…

CMS Updates ABN Chapter of the Medicare Claims Processing Manual

The Centers for Medicare & Medicaid Services (CMS) recently revised the Advance Beneficiary Notice of Non-coverage (ABN) section 50 in chapter 30 of Pub. 100-04, Medicare Claims Processing Manual via Transmittal l 10862/Change Request (CR) 12242. The changes are primarily a reorganization of the material, clarifications, and updates.  For instance, some of the examples used…

CMS Issues Manual Instructions for the Home Health NOA

The Centers for Medicare & Medicaid Services (CMS) has issued Change Request (CR) 12256, Replacing Home Health Requests for Anticipated Payment (RAPs) with the Notice of Admission (NOA). The CR updates multiple sections of the Chapter 10 of the Medicare Claims Processing Manual to reflect requirements for the Patient Driven Groupings Model such as adding “Notice of Admission” when applicable and replacing the phrase “60 day…

CMS Corrects Conflicting Policies On Who May Sign Home Health POC, Recertification

The Centers for Medicare & Medicaid Services (CMS) has issued Change Request (CR) 12218, which updates the Medicare Benefit Policy Manual, chapter 7 to correct information on who may sign the certification and recertification for home health patients, and includes instructions for the no -pay request for anticipated payment (RAP). In November 2020, CMS updated chapter…

CMS Updates Hospice Claims Processing Instructions

The Centers for Medicare & Medicaid Services (CMS) recently updated the hospice chapter of the Medicare Claims Processing Manual, changing the billing and processing instructions.  Change Request (CR) 12026 clarifies that in order for the Notice of Termination/Revocation (NOTR) to be accepted into the system, an election period must be established. If the notice of…

CMS Updates Hospice Claims Processing Instructions

The Centers for Medicare & Medicaid Services (CMS) has upted Chapter 11 of the Medicare Claims Processing Manual (Pub 100-04), with the new Transmittal 10173/Change Request (CR) 11807. This CR makes updates to the manual language regarding submitting Notice of Termination/Revocation (NOTR), Processing Professional Claims for Hospice Beneficiaries, and section 30.3 about the Data Required on the…

CMS Issues New G-Codes and Other Claims Processing Instructions

The Centers for Medicare & Medicaid Services (CMS) has issued Change Request (CR) 11721, two new G-codes to indicate on home health (HH) claims when maintenance therapy is provided by a therapy assistant. The CR also provides various clarifying changes to the Medicare Claims Processing Manual, chapter 10, in order to better reflect the policies…

Changes to Requirements for Billing Physician Home Visits

The Centers for Medicare & Medicaid Services (CMS) recently released Transmittal 439/Change Request (CR) 11273, Documentation of Medical Necessity of the Home Visit; and Physician Management Associated with Superficial Radiation Treatment. The new transmittal updates the Medicare Claims Processing Manual, Pub. 100-04, Chapter 12, Section 30.6.14.1 – Home Services to reflect the elimination of the…

CMS Releases Additional Instructions for Claims under PDGM

The Centers for Medicare & Medicaid Services (CMS) has released a second set of revisions to Chapter 10 of the Medicare Claims Processing Manual providing instructions to home health agencies for claims submission under PDGM. CMS Transmittal 4294/Change Request (CR) 11272, Home Health (HH) Patient-Driven Groupings Model (PDGM) – Additional Manual Instructions, provides some clarity…

CMS Updates Hospice Chapter of Medicare Claims Processing Manual

The Centers for Medicare & Medicaid Services (CMS) released Transmittal 4280/Change Request (CR) 11205, Update to Pub. 100-04, Chapter 11.    This CR updates the Hospice chapter of the Medicare Claims Processing Manual to reflect: Language regarding billing for physician assistants as attending physicians Clarification of hospice election periods and benefit periods (same meaning for claims…