Posted Saturday, April 23, 2022
Earlier this month, CMS issued Change Request (CR) 12657, removing the requirement to submit a Notice of Admission (NOA) before billing for home health denial notices. The CR also revises home health edit criteria to ensure Medicare systems calculate 60-day gaps in service consistently.
CMS’ long-standing policy to exclude billings for denial from a Request for Anticipated Payment (RAP) submission erroneously has not been applied the Notice of Admission. The CR corrects this, ensuring claims with TOB 320 and condition code 21 are accepted when a NOA is not present and that these claims trigger no updates to HH periods of care.
A sequence of related home health periods of care is defined beginning with an admission to home health services and ending when there is a 60-day gap in home health services.
Medicare administrative contractors recently identified a minor variance between the way the 60-day gap is counted and used for these two purposes. The CR revises the counting method used for identifying LUPA add-ons, in order to create consistency.
Source: NAHC
About Corridor
For over 30 years, Corridor has partnered with home-based care providers, delivering powerful solutions to support the unique challenges of caring for patients in the home. Our team of operating executives, clinicians, and nationally renowned industry experts have run provider organizations and resolved the same challenges you face.
Focusing on key operational, regulatory and financial challenges, Corridor delivers solutions and deep expertise in coding, clinical documentation, compliance, billing and education.
To receive the most important industry updates, insights and news impacting home health and hospice, please make sure to sign up for our weekly newsletter
