Rx2000
Institute
11824 Wayzata Blvd
Minneapolis, MN 55305
Phone: 952-595-9551
FAX: 952-513-1544
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Avoid common billing
errors on HH PPS RAPs and claims
HCFA has been alerted by the Regional Home Health
Intermediaries (RHHIs) that a number of home health PPS RAPs and claims are being returned to providers
due to several easily avoidable billing errors. The most common of these errors
are:
1) Source of Admission Code missing -- HH PPS RAPs and claims cannot be processed without a valid code being present in the Source of Admission
field (FL 20) on the UB-92 claim form. Ensure that this field is completed on
all HH PPS submissions. A list of valid codes for Medicare is available in the
recent revision to HCFA's Home Health Agency Manual, in section 475.1.
2) Claims-OASIS matching key missing -- HH PPS RAPs and claims cannot be processed without a code being present in the Treatment
Authorization Code field (FL 63) on the UB-92 claim form. Ensure that this field is completed
on all HH PPS submissions. The claims-OASIS matching key is an eighteen
character
numeric code containing three data elements from the OASIS assessment used
to produce the RAP or claim--the eight digit start of care date, the eight
digit assessment date and the two digit reason for assessment code.
3) Admission Dates prior to October 1, 2000 -- HCFA's instructions for submission of RAPs and claims during the period of transition to HH PPS
(PM A-00-41) indicated that admission dates on HH PPS RAPs and claims must be
October 1, 2000, or later. If a patient was admitted prior to October 1,
2000, providers were instructed to submit October 1, 2000 as the admission
date for these patients.
4) MSA codes missing or invalid -- Home health providers were required
prior to HH PPS to report a Metropolitan Statistical Area (MSA) code corresponding
to the site the patient was served. This requirement continues under HH PPS.
HH PPS RAPs and claims cannot be processed without an MSA code being present in
one of the value code fields (FLs 39-41) on the UB-92 claim form accompanied by
value code 61. In addition to ensuring this code is present, ensure that the
code submitted is a valid MSA code, that the code is appropriate to your
service area and that the decimal place in the value amount is correct.
Taking steps to avoid these common billing errors, or to correct them
quickly
when identified, will help assure timely and accurate payments under the
HH PPS.
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