License for Use of "Physicians' Current Procedural Terminology", (CPT) Fourth Edition

End User/Point and Click Agreement: CPT codes, descriptions and other data only are copyright 2009 American Medical Association (AMA). All Rights Reserved (or such other date of publication of CPT). CPT is a trademark of the AMA.

You, your employees and agents are authorized to use CPT only as contained in the following authorized materials including but not limited to CGS fee schedules, general communications, Medicare Bulletin, and related materials internally within your organization within the United States for the sole use by yourself, employees, and agents. Use is limited to use in Medicare, Medicaid, or other programs administered by the Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement.

Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized here in must be obtained through the AMA, CPT Intellectual Property Services, 515 N. State Street, Chicago, IL 60610. Applications are available at the AMA website.

This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2)(June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a)(June 1995) and DFARS 227.7202-3(a)June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department Federal procurements.

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CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. AMA warrants that due to the nature of CPT, it does not manipulate or process dates, therefore there is no Year 2000 issue with CPT. AMA disclaims responsibility for any errors in CPT that may arise as a result of CPT being used in conjunction with any software and/or hardware system that is not Year 2000 compliant. No fee schedules, basic unit, relative values or related listings are included in CPT. The AMA does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this file/product is with CGS or the CMS and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This Agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this Agreement.

CMS Disclaimer

The scope of this license is determined by the AMA, the copyright holder. Any questions pertaining to the license or use of the CPT must be addressed to the AMA. End Users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CPT. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL CONTAINED ON THIS PAGE. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.

This license will terminate upon notice to you if you violate the terms of this license. The AMA is a third party beneficiary to this license.

POINT AND CLICK LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT")

End User License Agreement

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Subject to the terms and conditions contained in this Agreement, you, your employees, and agents are authorized to use CDT-4 only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. Use of CDT-4 is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT-4. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials.
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Demand Billing Information Sheet for Home Health Providers

Please use the tips below to help ensure your home health demand bill processes successfully in the Fiscal Intermediary Standard System (FISS).

RAPs/final claims must be submitted timely to Medicare.

Dates of service on Medicare claim	Must be filed
On/after January 1, 2010	Within one calendar year after the date of service

When a Request for Anticipated Payment (RAP) or claim is stopped for an error (RTP), it will be given a new received date (REC DT) when resubmitted (F9). This new date must also adhere to the timely filing standards.
Timely filing requirements also apply to claim adjustments and cancels (type of bills 3X7 and 3X8).

Review ELGH Page 3 and ELGA Page 4.
- HHAs should review these screens prior to submitting all RAPs or claims (including demand bills) to Medicare.
- Enter the first calendar day of the episode in question (or one day prior to this) in the APP DATE field when accessing ELGA or ELGH to determine episodes established for the beneficiary, which will impact the dates of service being billed.
RAPs are required in demand billing situations.
- A RAP must be submitted and processed (FISS status/location P B9997) prior to sending a demand bill to Medicare.
"TO" date on claims should be Day 60.
- Ensure that 60-day episodes are billed in form locator (FL) 6 of the CMS-1450 claim form.
- Episodes are less than 60 days only when an intervening event occurs (beneficiary discharge, transfer, or enrollment in a Medicare Advantage (MA) plan) prior to the 60 th calendar day.
- To assist in calculating correct episode dates, access the OASIS calendar. You will need to scroll down to "OASIS Follow Up Assessment Scheduling Calendar" to download or print episode calendars.
Ensure type of bill (TOB) is correct.
- Enter 322 in FL 4 for RAPs.
- Enter 329 in FL 4 for final claims (including demand bills).
Demand bills require condition code "20".
- Condition codes are entered in FL 18-28.
- RAPs (TOB 322) should never contain condition code "20".
Use Medicare revenue codes in FL 42 and HCPCS codes in FL 44.
- Medicaid codes are not acceptable on Medicare claims.
- Access the Medicare Claims Processing Manual (Pub. 100-4, Ch. 10, §40.2) for a listing of appropriate codes used on home health claims. The information begins under the header "FL 42 and 43 Revenue Code and Revenue Description"
- Access the Medicare Claims Processing Manual (Pub. 100-4, Ch. 25, § 75.4) for detailed information about revenue code sub-classifications.
Verify required revenue code line information is included.
- Revenue code 0023 (entered in FL 42) is required along with the HIPPS code (entered in FL 44) and first Medicare covered, billable visit (entered in FL 45) on all home health RAPs and final claims, including demand bills.
Include all services reflected in the patient's record on the demand bill.
- In addition, ensure all services are billed with the appropriate revenue code (i.e. 0420 is used for physical therapy, 0551 is used for skilled nursing services, 0571 is used for aide services, etc.)
Demand bills must contain non-covered charges.
- Services for which Medicare is not liable must be entered as non-covered in FL 48 on demand bills.
Adjust previously submitted home health claims to add non-covered charges.
- When an HHA has previously billed an episode of care for the beneficiary, and non-covered charges need to be submitted for the episode's dates of service, the previously processed final claim should be adjusted.
- The TOB for adjustments is 327 or 337.
- Claim Change Reason Code D9 should be keyed into the first available condition code field (FL 18-28). Condition code fields are located of FISS Page 01.
- If FISS is used to submit the adjustment, 'RM' must be entered in the adjustment reason code field on FISS Page 03.
- Make sure to enter condition code 20 in FL 18-28, so that the adjustment processes as a demand bill.
- Remarks are required on claim page 04 of FISS (FL 80) to explain the reason for the adjustment and demand bill.
- Not adjusting existing claims can cause billing problems including duplicate billing, overlapping home health episodes, and reduced payment for the previously paid episode due to a partial episode payment (PEP).
Medicare claims (including demand bills) that are rejected (FISS status code R) cannot be appealed.

FISS Screen Prints Home Health Demand Bill Completion

RAP

Bill RAP as usual. RAPs are required to be submitted for every episode for which a demand bill will be submitted. (CMS Pub. 100-04, Ch. 10, §50.C)
- Note: RAPs should not contain condition code 20

CLAIM

PLEASE NOTE: Claim Pages 03 and 05 are submitted as usual for demand billing situations. The above screenprints are provided to highlight how Claim Pages 01, 02 and 04 should appear when appropriately submitting demand bills to Medicare.