CMS Issues Manual Updates Related to PDGM

Posted on Monday, November 18, 2019 12:52 PM

CMS issued change request (CR) 11527 last week, which updates the Claims Processing Manual chapter 10 regarding PDGM.

The CR explains that a beneficiary is not required to be discharged from home health services if their stay spans across two 30-day periods within a certification period. The 30-day periods are contiguous, even if the patient returns to the agency after the beginning of the next 30-day period. The agency should submit the request for anticipated payment (RAP) and the claim with the “from” date as day 31 of the next period and the first visit date after discharge from the facility. The home health claim will process if there are no dates of service on the claim that overlap the dates of service for the inpatient stay.

The CR also establishes a process to address 30-day periods where there are no visits because the POC requires visits less frequently than every 30 days.

Source: NAHC Report

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