September
17, 2013
Drill Down –
Home Health Consolidated Billing and Therapy Services
Before a
provider of therapy services initiates those services to the Medicare
beneficiary, the provider would need to determine whether or not a Home Health
episode of care exists for that beneficiary.
This audit issue references the Centers for Medicare and Medicaid (CMS)
Medicare Benefit Policy and Medicare Claims Processing Manuals.
A therapy
provider should ask the beneficiary or their authorized representative, if
he/she is presently receiving Home Health services under a home health plan of
care. Beneficiaries and their representatives should have the most complete
information regarding Home Health care status. Therapy providers may document
information from the beneficiary that states the beneficiary is not receiving
Home Health care but such documentation in itself does not shift liability to
either the beneficiary or Medicare for any denied claims.
To determine
if the Medicare beneficiary is under Home Health plan of care, contact the Medicare
contractor’s toll free number to request Home Health eligibility. Institutional
providers (providers who bill using the institutional claim format) may access
this information electronically through the Home Health Common Working File
(CWF) inquiry process. Independent therapists or suppliers who bill using the
professional claim format also have access to a similar electronic inquiry via
the HIPAA standard eligibility transaction – the 270/271 transaction.
As an aid to
suppliers and providers subject to Home Health consolidated billing, Medicare
systems display, for each Medicare beneficiary, the code for certification
(G0180) or recertification (G0179) and the date of service for either of the
two codes.
RAC Region A
Performant
Independent Therapy Provider
§ Home Health
Consolidated Billing and Therapy Services - JL - According to the Medicare Benefit Policy Manual, Chapter
7, Section 10.11 (A) (Home Health Services Consolidated Billing), therapy
services (physical, occupational, and speech-language pathology) are bundled
into the Home Health Prospective Payment System (HH PPS) reimbursement made to
the Home Health Agency (HHA), while the patient is under a home health plan of
care. Medicare does not make separate payment made to the independent therapy
provider.
Outpatient Hospital
§ Trastuzumab
(Herceptin®), Multi-dose Vial Waste -
Per its package label, Trastuzumab (Herceptin®) is supplied by the manufacturer
in a 440 mg multi-dose vial. Per Medicare Claims Processing Manual (100-04)
Chapter 17, §40: "When a physician, hospital or other provider or supplier
must discard the remainder of a single use vial or other single use package
after administering a dose/quantity of the drug or biological to a Medicare
patient, the program provides payment for the amount of drug or biological
discarded as well as the dose administered, up to the amount of the drug or
biological as indicated on the vial or package label. Note: Multi-use vials are
not subject to payment for discarded amounts of drug or biological."
Physician/Non-Physician Practitioner
§ Trastuzumab
(Herceptin®), Multi-dose Vial Waste -
Per its package label, Trastuzumab (Herceptin®) is supplied by the manufacturer
in a 440 mg multi-dose vial. Per Medicare Claims Processing Manual (100-04)
Chapter 17, §40: "When a physician, hospital or other provider or supplier
must discard the remainder of a single use vial or other single use package
after administering a dose/quantity of the drug or biological to a Medicare
patient, the program provides payment for the amount of drug or biological
discarded as well as the dose administered, up to the amount of the drug or biological
as indicated on the vial or package label. Note: Multi-use vials are not
subject to payment for discarded amounts of drug or biological."
§ Maximum Allowed
Units for Part B Drugs and Biologicals - JL - Potential incorrect billing occurred for claims billed in excess of
the maximum allowed units for Part B drugs and biologicals, when no additional
supporting documentation is received from the provider for complex review
within the 45-day response period.
§ Billing for
Dead Beneficiaries - Jurisdiction K -
Medicare does not pay for services provided after the beneficiary's date of
death.
§ Billing for
Dead Beneficiaries - Jurisdiction L -
Medicare does not pay for services provided after the beneficiary's date of
death.
No comments:
Post a Comment