Agencies’ payments may change as a result of two corrections CMS is making the 2015 Home Health Pricer program.
 
The corrections, which take effect starting Oct. 5, are likely to affect a lot of home health claims — but these changes are also likely to have a minor dollar impact for individual agencies, says Aaron Little, managing director of Springfield, Mo.-based BKD.
 
Make sure billers at your agency rebalance any payment changes related to the CMS corrections, Little says.
 
The first correction concerns the fact that the 2015 Home Health Pricer currently uses a table that contains incorrect case-mix weights for all HIPPS codes beginning with ‘4,’ CMS says in change request 9198.
 
The weights for all codes beginning with 4 are using the weight for the corresponding code that begins with ‘2’ so that, for example, a claim submitted with HIPPS codes 4AFKS is being paid using the weight for 2AFKS. The change request corrects the weight table and instructs Medicare administrative contractors (MACs) to adjust claims to correct payments for agencies.
 
This error could result in underpayment to some agencies, in part depending on a particular agency’s core based statistical area and other calculations, says consultant Thelma Bowen of HealthCare Compliance Services in San Antonio.
 
Remember, the first number of the HIPPS code is the grouping number, Bowen says. The 2 means early episodes with 12-19 therapy visits, while the 4 means later episodes with 14-19 therapy visits. It’s not likely that most agencies have many HIPPS codes that begin with 4, Bowen says.
 
Table instructions contain error
 
Agencies should also note change request 8950. This correction involves re-coding instructions for the Home Health Pricer that contained an error in a table used when HIPPS codes beginning with ‘1’ or ‘2’ are submitted with 20 or more therapy visits and must be re-coded to a HIPPS code beginning with ‘5,’ CMS says.
 
If the clinical severity value encoded in the treatment authorization codes was a ‘D,’ the claim was re-coded into a higher case-mix group in error, CMS says. The change request, then, involved including instructions to MACs to adjust claims to correct payments.
 
In this case, it may be that some agencies may have been overpaid and would thus see a reduction in payment resulting from this change, Little says.
But again, the level of scrutiny and the amount of time and effort it would take to discern how this may affect an individual agency is likely not worth what will result in a minor payment adjustment, he says.
 
It would also make sense for agency billers to be aware of any possible changes in payment resulting from this change and to rebalance payments to the agency once the MACs make the related changes to payment, Little adds.
 
Transmittal announces consolidated billing update
 
In a recent transmittal, CMS included a list of updated Healthcare Common Procedure Coding System (HCPCS) codes used by Medicare systems to enforce consolidated billing of home health services.
 
Change request 9192 includes the addition of HCPCS codes 97607 and 97608, negative pressure wound therapies, to the home health consolidated billing therapy code list, effective for services on or after Oct. 1, 2015, CMS says.
 
These codes replace G0456 and G0457, negative pressure wound therapies. Also, A7048, or vacuum drainage collection and tubing unit, including related supplies, will replace A7043 on the home health consolidated billing non-routine supply code list effective Oct. 1, 2015.
 
Remember that the consolidated billing provision is updated periodically, at least annually, by CMS and that services that appear on the related list that are submitted on claims to MACs won’t be paid separately on dates when a beneficiary is in a home health episode, CMS says. Medicare will only directly reimburse the primary agencies that have opened such episodes during the episode period.
 
Related links: Find the change requests for Home Health Pricer changes here: http://tinyurl.com/om5hfcv. Find more on the HCPCS consolidated billing updates at: http://tinyurl.com/orpan89.