CMS has updated its four-page “Original Medicare vs. Medicare Advantage” fact sheet to highlight home health payment requirements around a patient’s shift between fee-for-service and an MA plan.
The update notes:
If patients enroll in an MA plan during the 30-day period that includes all home health services, CMS will proportionately adjust the 30-day period payment with a partial payment adjustment since the patient is receiving coverage under MA. Starting with the effective date of enrollment, the MA plan will get a capitation payment for covered services.
In cases where a home health agency knows in advance that a patient will become enrolled in an MAO as of a certain date, submit a claim for the shortened period before the MAO enrollment date and code the claim with patient status 06.