Home Health and Hospice (HH&H) What's New ACT
View the handoutfor the December 21, 2016, Home Health and Hospice (HH&H) What's New ACT.
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- With the new Disposable Negative Pressure Wound Therapy (NPWT), please elaborate on the "how-to" when separating out the billable versus the non-billable. For example, there are scenarios where the clinician may do a start of care where the whole visit is to do teaching and training of the disposable wound vac and subsequent visits to assess for s/s of infection and then d/c of the wound vac – how would this be billed versus a start of care where the disposable wound vac is only part of what the skilled need is for the patient. Is the NPWT disposable vac billed under non-routine supplies? Or, is it under an outpatient code, and if so, can a Home Health bill under an outpatient code? Is the visit/service as well as the equipment billed separately or under one code?
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With the Negative Pressure Wound Therapy (NPWT) – the Consolidated Appropriations Act of 2016 requires separate payment to home health agencies (HHAs) for applicable disposable device when furnished on or after 1/1/17 using CPT codes 97607 and 97608. Please refer to Change Request (CR) 9736 or your CPT Coding Manual for complete descriptions of these codes. However, the major difference in these CPT codes is the wound surface area.
HHAs must bill separately for any patient visit conducted solely for NPWT and bill separately for any time spent providing NPWT when visit is for multiple purposes. CMS offered further clarification for when providers will bill for this procedure:
When a HHA furnishes NPWT using a disposable device i.e. the HHA is furnishing a new disposable NPWT device which means the HHA is either initially applying an entirely new NPWT device or removing a disposable NPWT device and replacing it with an entirely new one.
In each case, all services associated with NPWT i.e. conducting a wound assessment, changing dressings, and providing instructions for ongoing care should be reported on type of bill (TOB) 34X with the appropriate CPT 97607 or 97608 and should not be reported on the traditional 32X TOB. Payment for services on the 34X TOB will be paid from the Outpatient Perspective Payment System (OPPS) and there is a patient coinsurance of 20%.
Added: 02.02.17
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- Hospice claims dating back to July 2016 suspended for reason code 32402. Each time I have called Provider Services, I am told there is no resolution at this time. Is there an update on when this will be corrected?
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As of 12/21/2016, claims suspended with reason code 32402 have begun to process. We apologize for this inconvenience. Please contact the Provider Contact Center (PCC) if you encounter this issue in the future.
Added: 02.02.17
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- 3. Hospice flu shot claims billed prior to the actual monthly billing are causing rejections of the monthly claim with the reason stating it overlaps previous billing. Hospice flu shots billed after the monthly billing are paying correctly. Do I need to back out the paid claim for the flu shot in order for the monthly claim to process for payment then rebill the flu shot?
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The Centers for Medicare and Medicaid Services (CMS) and the Common Working File (CWF) are aware of this issue.
If your monthly hospice claim is in RTP with reason code U5601 because the vaccination claim has processed, you may cancel (XX8) the vaccination claim. Once canceled, you may F9 the monthly hospice claim from the RTP file to continue processing. Wait for it to finalize, and then rebill the vaccine claim. The Vaccine claim should then received U5601 and we can move it to the hold location.
Added: 02.02.17
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- CWF has incorrect date of death. Social Security office has correct information. I have unpaid claims dating back to May 2016 due to the error in CWF. How long will it take to update the CWF?
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We are still awaiting the provider instructions from CMS about this matter. Providers are encouraged to contact our PCC regarding impacted claims to see if there are any workarounds in the interim of CMS instructions concerning MAC adjustments.
Added: 02.02.17
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- My question is in regards to Home Health MM9585 with the OASIS submission that will begin April 1st. I initially didn't think this was going to be an issue except for yesterday; we had a situation where we have a chemo takedown every two weeks. Our nurse went in and the patient indicated – but the nurse really probed her that her insurance had changed. This patient initially started out on commercial insurance and after the nurse probed her a little bit we found out that she had switched to Medicare. After we looked in the Medicare system, this patient's insurance change actually happened on November 1st. So per OASIS guidelines we have to discharge out of agency and do a new start of care from the nearest visit date which was 11/10. So the nurse had to do all that paperwork, well then we have to submit that to the ASAP. So my question is, do I make that new 90 days the date the nurse did that assessment because it's over 30 days?
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The face-to-face you had previously can still be used as long as it was no more than 90 days prior to the start of care and meets all of the other face-to-face requirements.
Added: 02.02.17
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- I have a question about the NPWT. If we're using the non-disposable wound VAC, do we need to do anything differently?
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No, because CR9736 is specific to the disposable devices. So if you're using the non-disposable ones, then you're going to seek payment using the method that you've been using in the past.
Added: 02.02.17
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