Home Health Claims Filing
The Fiscal Intermediary Standard System (FISS) Claims/Attachments option (FISS Main Menu Option 02) allows you to enter home health Requests for Anticipated Payments (RAPs) and final claims. The following provides screen prints and field descriptions for each FISS claim page and identifies which fields are required for RAPs, final claims, and home health outpatient claims, and the data required in those fields. Information is also provided about specials claims filing situations.
For more information about the Home Health Prospective Payment System (HH PPS), go to the Home Health PPS Web page, which is available on the Centers for Medicare & Medicaid Services (CMS) Web site, the Medicare Claims Processing Manual (CMS Pub. 100-04, Ch. 10). In addition, CMS offers the Home Health Prospective Payment System Fact Sheet for your reference.
There are six claim pages within FISS:
Special Claims Filing Situations
- Beneficiary Elected Home Health Transfer
- Billing HH PPS Claims with Non-Routine Supplies (NRS)
- Billing Osteoporosis Drugs for Home Health Beneficiaries
- Billing Vaccination Claims
- Correcting Home Health Episode Information Posted to the Common Working File (CWF)
- Discharge and Readmit for Home Health
- Home Health Demand Denials (Condition Code 20)
- Home Health No-Payment Billing (Condition Code 21)
- Home Health Outpatient Therapy Billing
- Impact of an Inpatient Admission During an HH PPS Episode
- Medicare Advantage (MA) Plans — Claim Filing Tips When A Beneficiary Receiving Home Health Services Enrolls / Disenrolls
- Newly Certified Home Health Provider or Provider Number Changes
Additional Resources
This CMS fact sheet offers an overview of the UB-04, also known as the Form CMS-1450, which is the uniform institutional provider hardcopy claim form suitable for use in billing multiple third party payers.
Attending Physician Editing
Change Request (CR) 6856 expands editing to verify that the attending physician's National Provider Identifier (NPI) is valid, and to ensure that the attending physician is enrolled in Medicare and is in Medicare's Provider Enrollment, Change and Ownership System (PECOS). The CMS has a PECOS Monthly Ordering and Referring report available that contains the NPI for all physicians who are of a type/specialty that are eligible to order and refer beneficiaries for home health services. For additional information refer to the Medicare Learning Network (MLN) Matters article MM6856 .
Consolidated Billing Master Supply List
This list is maintained and updated annually by CMS and contains the nonroutine supplies that are included in consolidated billing under the HH PPS.
Section 6404 of the Patient Protection and Affordable Care Act (PPACA) amended the timely filing requirements to reduce the maximum time period for submission of all Medicare claims , including adjustments and cancels, to one calendar year after the date of service.
Medicare Claims Processing Manual (CMS Pub. 100-04, Ch. 10)
Chapter 10 of the Medicare Claims Processing Manual describes bill processing requirements that are applicable only to home health agencies.
National Uniform Billing Committee (NUBC)
Refer to the NUBC Web site for a complete description of all the items included on the CMS-1450 (UB-04) claim form.
Home Health Quick Resource Tools
A variety of tools developed by the CGS Provider Outreach and Education staff are available to assis in the successful processing of your claims.
Updated: 10.04.11
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