Nonroutine Supplies:
NRS Edits Hit HHAs' Claims
Published on Tue Mar 25, 2008
Overcome confusing remittance advice codes with NRS know-how.
Don’t ignore the new nonroutine supplies edits or you could pay a steep price very soon.
The Centers for Medicare & Medicaid Services drastically changed how home health agencies receive payment for NRS when prospective payment system revisions took effect Jan. 1.
Then: CMS included the same flat $52.53 rate for supplies in all episodes.
Now: Agencies receive payment at six severity levels ranging from $14 to $551 based on 11 OASIS items including diagnosis coding. “Points translate into … NRS revenue, which is a whole different concept than we’re used to,” consultant Lynda Laff said in a March Eli-sponsored audioconference, “A Closer Look at Supply Management in the 2008 PPS Era.”
Seventy-six diagnosis codes now can trigger NRS points, said Laff, with Laff Associates in Hilton Head Island, SC. Relevant OASIS items are M0230, M0240, M0250, M0450, M0470, M0474, M0476, M0488, M0520, M0540 and M0550.
Is that right? A hard concept for agencies to understand is that they receive the same NRS payment regardless of the supplies they furnish to the patient or report on the claim.
The NRS payment is based on how you answer the underlying OASIS questions, not on what supplies you include on the claim, emphasized billing expert M. Aaron Little in another recent Eli-sponsored audioconference, “Crash Course: Crucial Lessons Your HHA Billing Staff Must Know For 2008.” When you use the HIPPS code saying you furnished no supplies to the patient, you still receive the full NRS payment.
“That may not be that way forever,” cautioned Little, with BKD in Springfield, MO. “But as it stands today, that is how it works.”
Details: HHAs must report NRS on claims using two revenue codes, CMS noted in Nov. 2, 2007 Transmittal No. 1371 (CR 5776). When the agency doesn’t furnish supplies, it indicates that by using a number instead of a letter in the fifth position of the HIPPS code.
New edits: Beginning April 7, the intermediaries implemented informational claims edits that check for supplies codes, a CMS source confirms to Eli. If a claim has a HIPPS code that indicates the agency furnished supplies by using a letter in the fifth position, the claim must also include a line item for NRS and related charges.
If the claim includes a HIPPS code ending in a number, which indicates the submitting agency did not furnish NRS to the patient, then the claim won’t undergo the NRS edit check.
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