Billing:
TACKLE THESE 9 BILLING TO-DOs BEFORE PPS REFINEMENTS HIT
Published on Mon Oct 01, 2007
M0110 accuracy could make or break your 2008 claims.
Your prospective payment system billing is about to get a lot more complicated, and your bottom line could suffer if you don't know the ropes.
Under PPS refinements hitting Jan. 1, home health agencies will categorize patients into 45 home health resource groups (HHRGs), noted consultant M. Aaron Little in an Oct. 24 Eli-sponsored audioconference on the billing changes. That number is down from the 80 current HHRGs because the Centers for Medicare & Medicaid Services cut one severity level from the Clinical dimension and two levels from the Functional dimension. CMS did add a level to the Service dimension, however.
But a smaller group of HHRGs leads to a higher number of case mix categories and a whole lot more billing codes, pointed out Little, with BKD in Spring-field, MO. PPS will go from the current 80 case mix categories to 153 categories. And the system jumps to 1,836 unique HIPPS codes.
To master the billing changes, Little suggested agencies take these steps: 1) Understand the basics. Your billers should have a fundamental understanding of how the new system groups patients into payment categories. Learning how the five grouping categories work based on early/ late episodes and therapy thresholds is key, as well as understanding the Clinical, Functional and Service di-mensions and the Nonroutine Supplies (NRS) categories. 2) Examine the new codes. Billers should grasp the significance of the new HHRGs and HIPPS codes, including what each position in the codes stands for. And the 18-digit OASIS matching string has a critical new importance under PPS refinements, Little stressed. 3) Become a M0110 expert. The patient's whole payment grouping will depend on the early vs. late episode designation, Little explained. Billers must become adept at determining episode status by checking the Common Working File.
But the M0110 work doesn't stop there. Clerical staff must also communicate the correct ep-isode sequence information to the clinician filling out OASIS, Little counseled.
Tricky: Counting episodes may prove difficult at times. Agencies should remember that previous episodes furnished by other providers count in the sequence. And the definition of "adjacent" episodes means that agencies count episodes that are up to 60 days apart.
Tip: When checking the HIQH page on the CWF, the two most recent episodes display. But providers can check back further for episodes by using the "APP DATE" field to enter a requested date, Little advised a caller. 4) Verify therapy visits. Making sure an episode's therapy visits are on the final claim is more important than ever, Little noted. Under the PPS refinements, most visits between six and 20 mean extra payment (see chart, Eli's HCW, Vol. XVI, No. 33). One denied visit can mean a $1,400 [...]
