Beneficiary Elected Home Health Transfer
Beneficiaries under a home health plan of care may choose to transfer from one home health agency (HHA) to another at any time. Medicare regulations permit them to do so as often as they choose. Under Home Health Prospective Payment System (HH PPS) consolidated billing requirements, there can only be one primary home health agency that establishes a plan of care for beneficiaries (who meet the coverage requirements), provides all home health-related services (either directly or under arrangement), and bills Medicare for reimbursement. Medicare will only reimburse the primary home health agency for home health services during an episode.
When a beneficiary decides to transfer to another HHA, refer to the following information, depending upon whether you are the transferring or receiving agency.
- Discharge the beneficiary from your care; and
- Document contact from the receiving home health agency notifying you of the transfer.
The original 60-day episode, which was established by the transferring agency, ends, and the transferring agency, receives a Partial Episode Payment (PEP).
- Establish a new start of care date and plan of care, which will begin a new 60 day episode
- Document the beneficiary was informed that the original home health agency
will no longer receive Medicare payment and will no longer
provide Medicare covered services to them after the transfer is effective.
- We encourage HHAs to include language in their admission paperwork to inform beneficiaries that there can only be one HHA in the home during an episode of care and that any other HHA will not receive payments from Medicare. This documentation is important if a dispute occurs between the original and receiving HHA.
- Access the Medicare beneficiary eligibility system to determine whether the patient is under an established home health plan of care. See the CGS Checking Beneficiary Eligibility web page for more information about the systems available to providers to check Medicare beneficiary eligibility information.
- A screen print of the beneficiary’s home health episode history dated at the time the receiving agency admitted the beneficiary is required to document this. Apply a time/date stamp if the screen print does not include the date and time when printed.
- Contact the initial home health agency regarding the effective date of the transfer. This contact documentation must include:
- Beneficiary's name;
- Beneficiary's health insurance claim number (HICN);
- Name of home health staff person who was contacted; and
- The date and time of the contact.
- The receiving home health agency now becomes the "primary" agency and assumes the responsibility to notify the beneficiary that all services under the HHA's plan of care (POC) need to be provided by the primary agency (the HHA that is overseeing the POC).
- To avoid billing errors in a transfer situation, the receiving agency must enter a condition code (FL 18-28) "47" on the first RAP and claim that is billed for the beneficiary after the transfer is completed.
- Receiving agencies are reminded that it is not appropriate to bill a condition code 47 if they have not followed the "receiving home health agency responsibilities" outlined above.
NOTE: It is not considered a transfer if it is between HHAs of common ownership.
- The Medicare Claims Processing Manual (Pub. 100-4, Ch. 10, §10.1.13, 10.1.15 & 20.1.1)
- The Medicare Benefit Policy Manual (Pub. 100-2, Ch. 7, §10.8.E)
- Medicare Learning Network (MLN) Matters article, MM7338, "Revisions to the "Medicare Claims Processing Manual" - Chapter 10 (Home Health Agency Billing)"
- Avoiding Billing Errors Caused By Overlapping Home Health Episodes quick resource tool
- Special Billing Situations Under HH PPS quick resource tool
- Top Claim Submission Errors for Home Health Providers: Error U538I webpage