CMS Issues Corrections to Claims Processing Policy and 60 Day Calculation Inconsistency

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

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