The Center for Medicare & Medicaid Services (CMS) has issued a change request CR8136 which adds new codes to the Home Health PPS claims. The two code changes are:

1. HCPCS code to indicate the location where patient services are provided.

2. A code to indicate when a physician, other than the certifying physician makes changes to care plans.

This change request will take effect for claims with episodes starting on or after July 1, 2013. These changes will affect all claims except the RAP (Request for Anticipated Payment) claim.

HCPCS Codes for Reporting the Location of Services Provided

CMS wants to add new data for reporting purposes to Home Health claims that have already been in use with Hospice claims since 2007. They have even borrowed the codes from hospice with definitions and just included Home Health Care in the definition. Home Health Agencies must report the new codes indicating the location of where patient services are provided. These code changes will affect the end of episode or final claim which will include: EOE, LUPA, PEP and Outlier type claims, due to these claims being the line item detail claim of the episode of care. The HCPCS codes with definitions are listed in table 1. There are six revenue codes that can be affected by this additional HCPCS code change. The list of revenue codes are in the table 2.

Table 1: HCPCS codes

Table 2: Revenue Codes

The HCPCS code must be listed with the first billable service for each episode. The recertification episode can have a first billable visit by any service ordered to provide care for the patient. The first billable visit can be made by a service other than the qualifying service such as the Home Health Aide making the first visit in a new recertification episode. This is the reason all six revenue codes above are affected by this code change.

The HCPCS code will be entered as a line item on the claim with the revenue code for the service that provided the first billable visit. This line item will have a unit of 1 and a charge amount i.e. $0.01. The first billable visit should be listed right next to this line item with the same date. Notice in the example below: The location of services line is the fourth entry down with the start of care OASIS visit right above. The Revenue codes correspond for both entries, followed by HCPCS codes, then the dates of service, units and total charges.

CR8136 also states the entry of this item on the visit line will not be counted in the total visits for the patient and will not be considered in payment in the HH Pricer that determines the payment for the episode of care. The Home Health agencies are still required to report the CBSA (Core Based Statistical Area) or patient zip code where the patient is residing at the time when services are rendered, as this data is included when the HH Pricer reviews for payment.

Additional Code to Indicate Changes Made by Physician Other than Certifying Physician

In Change request CR8136, CMS is introducing a code to indicate when a change is made to the care plan by a physician other than the certifying physician. The intent is to track data to show how often additional orders are added to the plan of care.   See example below as a skilled nurse visit was made with another order by a physician other than the certifying physician, the last visit listed here.

These code changes will be finalized with the final update for HCPCS code and modifier on March 31, 2013. After the finalization of the HCPCS code changes the CR8136 will be released again with the final ruling of the changes made. The effective date for all changes is services beginning on or after July 1, 2013.

These changes will be affecting software as well and will require an update to any and all software utilized for billing Medicare Home Health Claims. Begin now to educate the billing staff and discuss changes to software with your software vendor.

Axxess software customers will receive automatic updates to the software to accommodate all the changes associated with CR8136.  Axxess will announce a series of free webinars to educate home health agencies nationwide on CR8136 and how it will impact their businesses.

To learn more about the new CMS change request CR8136, please visit:

http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R2650CP.pdf