CMS has released a change request for the Medicare Claims Processing Manual to address instances when a patient is unexpectedly discharged after a “still patient” claim has been submitted.
 
The effective date for the change request is May 22, 2025.
 
While an agency may submit a still patient claim, some intervening event may prevent additional visits and the patient is discharged, CMS notes.
 
“In this situation, the agency shall submit an adjustment claim to correct the patient status code to reflect the discharge on their claim, since patient status code 30 may prevent billing of services subject to home health consolidated billing during the last days of the period of care,” the change request states.
 
The change request also updates the manual to update pricer layouts or logic for home health, hospice and SNFs to reflect the conversion from COBOL to Java, CMS notes.
 
Read the full change request at cms.gov.
 
The updated text at Chapter 1 §130.5 reads:
 
Several conditions can cause the claim for a HH period of care (Type of Bill 032x) to be adjusted. Claims may be cancelled (TOB 0328) by HHAs if a mistake is made in billing. In these cases, the period of care will be cancelled in CWF as well. Adjustment claims (TOB 0327) may also be used to change information on a previously submitted claim, which may also change payment.
 
A home health agency submits a corrected claim if any of the following apply (the list is not exhaustive):
• A change in provider number;
• A change in visits (decrease or increase);
• A change in diagnosis code or other claim elements affecting the determination of the HIPPS code used for payment; or
• A change in the patient status code affecting payment of the claim or the ability of other providers subject to HH consolidated billing to be paid for covered services.
 
Diagnosis codes on HH claims reflect the patient’s condition as of the start of a period of care (the claim From date). Errors in diagnosis codes which applied on the From date of a given period of care may be corrected with an adjustment claim. The HHA reports condition code D4 on the adjustment claim. Diagnosis codes that reflect a change in the patient’s condition during a period of care should be reflected on the claim for the next period.
 
An HHA may submit a claim with patient status code 30 (still patient) at the end of a period of care on the expectation that additional HH visits will be provided in the next period of care. Some intervening event may prevent the delivery of additional visits and the beneficiary is subsequently discharged. In this situation, the HHA shall submit an adjustment claim to correct the patient status code to reflect the discharge on their claim, since patient status code 30 may prevent billing of services subject to HH consolidated billing during the last days of the period of care. The HHA reports condition code E0 (zero) on the adjustment claim.