Home Health Reminder and CMS Update to PDGM Split Implementation Instructions

Posted on Monday, January 6, 2020 2:03 PM

Reminder: Home Health RAPs Hold

Medicare Administrative Contractors (MACs) usually hold claims for a short period each quarter when they implement system releases. However, starting January 1, 2020, home health Requests for Anticipated Payment (RAPs) are affected by implementation of the Home Health Patient-Driven Groupings Model. MACs will hold RAPs with From Dates on or after January 1, 2020 and process them once the updates are complete.

INSTRUCTIONS: Change Request 11081 Home Health (HH) Patient-Driven Groupings Model (PDGM) -Split Implementation

On December 20, 2019 Transmittal 4482/Change Request (CR) 11081 was released, replacing Transmittal 4244 from February 15, 2019. This new CR adds FISS as a responsible party to business requirement 11081.5.1 and adds a requirement and updates attachment 3 to facilitate handling claims with no matching assessment. Also, manual sections are updated to reflect changes made by subsequent transmittals for CRs 11272, 11527 and 11536. All other information remains the same

Source: NAHC Report


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