CMS and the Medicare Administrative Contractors (MACs) are alerting providers to new Home Health Grouper edits to identify some common coding errors.
 
The change request, effective April 1, 2023, will help identify various error conditions so providers can improve claims accuracy, according to CMS. If the diagnosis coding issues are identified, CMS returns the claim to the provider for correction.
 
These new Grouper edits apply to Types of Bill 032X (except 032A, 032D, and 0320). With this process, CMS may return claims with one of the following messages:
  • Unacceptable primary diagnosis, not reportable as primary
  • Manifestation code not reportable as primary diagnosis
  • Unspecified diagnosis code not acceptable as primary diagnosis
  • External cause of injury code not reportable as primary diagnosis
  • Primary diagnosis identified as a code first code with condition present
  • Primary diagnosis code is not valid for claim dates or is blank
CMS also noted a revision to NOA processing, particularly for patients transferring between home health providers.
 
When an agency sends an NOA indicating the patient transferred from another agency and the NOA From date falls within the period of care of the previous agency, CMS said it truncates the End date of the previous period to allow the transfer.
 
A previous change request addressed a problem when a transfer NOA was submitted in error and then cancelled, but it didn’t address the possibility that a claim corresponding to the previous period may have been paid a partial period payment adjustment in error.  The new change request creates a process to identify these claims and to adjust them to restore full payment for the period of care.
 
See the full MLN notice at https://go.cms.gov/3rHGMT4.