1. Home Health Billing What’s New With Medicare Billing Rules In 2013? May 6, 2013 F.O.R.C.E. Healthcare Resources, LLC (Founded on Regulatory Compliance and Ethics)

2. About F.O.R.C.E.? Home Health Consulting Firm – Founded 2005 Services Provided: 1.Home Health Billing Webinars 2.Home Health Outsource Billing 3.Home Health Outsource Medical Coding 4.Home Health Billing Clean-up Projects 5.Home Health Operation / Process Consulting 6.Home Health Financial Consulting 7.Home Health CLIA Billing & Recovery Project 2

3. Contact Information F.O.R.C.E Healthcare Resource, LLC. –Website: www.forcehealthcare.comwww.forcehealthcare.com Terri Ready, COO -Direct: 423-643-2256 ext. 104 -Mobile: 423-593-1627 -tready@forcehealthcare.comtready@forcehealthcare.com Lynn Alley, Billing Supervisor –Direct: 423-643-2256 ext. 107 –lalley@forcehealthcare.com 3

4. 2013 Updated Rules Effecting Billing Provider Enrollment, Chain, and Ownership System (PECOS) Requirements Surprise! Important Announcement Temporary Delay in Implementing Ordering and Referring Denial Edits – Due to technical issues, the implementation of the Phase 2 denial edits is being delayed. Home health claims that list attending physicians without a PECOS enrollment record will not be denied for now, CMS announced in an email message to Medicare providers April 25. http://www.cms.gov/Outreach-and- Education/Outreach/FFSProvPartProg/Downloads/2013-04-25Enews.pdf

5. 2013 Updated Rules Effecting Billing Sequestration 2% Reduction Medicare FFS claims with dates-of-service or dates-of-discharge on or after April 1, 2013, will incur a 2% reduction in Medicare payment. This reduction is currently being reported to last only one year, April 1, 2013, through March 31, 2014. http://www.cms.gov/Outreach-and- Education/Outreach/FFSProvPartProg/Downloads/2013-03-08-standalone.pdf

6. 2013 Updated Rules Effecting Billing Point Of Service Codes

7. 2013 Updated Rules Effecting Billing Point Of Service HCPCS Codes Effective with episode dates on or after July 1, 2013 Q5001: Hospice or Home Health providing care in patient’s home or residence. Q5002: Hospice or Home Health providing care in an assisted living facility. Q5009: Hospice or Home Health providing care in a place not otherwise specified (NOS). http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network- MLN/MLNMattersArticles/Downloads/MM8136.pdf

8. 2013 Updated Rules Effecting Billing Point Of Service Billing Requirements New HCPCS codes must be reported on a HH PPS claim containing the HH revenue code that corresponds with the first discipline billed or the claim will be returned to the provider. The line item date of service of the line reporting the Q code must match the first billable visit on the claim or the claim will be returned to the provider. When more than one line on an HH PPS claim reports a Q code then the same HCPCS code must not be reported on that claim or the claim will be returned to the provider. NOTE: Claim lines reporting Q codes are not included in visit counts passed to the HH Pricer, nor are they counted in medical policy parameters that count number of visits.

9. 2013 Updated Rules Effecting Billing Claim Status Category and Claim Status Codes Update Change Request (CR) 8265, requires Medicare Contractors to use only national Code Maintenance Committee-approved Claim Status Category Codes and Claim Status Codes when sending Medicare healthcare status responses (277 transactions) to report the status of your submitted claims. Proprietary codes may not be used in the X12 276/277 to report claim status. All code changes approved during the January 2013 Committee meeting will be posted on or about March 1, 2013, at http://www.wpc- edi.com/reference/codelists/healthcare/claim-status-category-codes/ and http://www.wpc- edi.com/reference/codelists/healthcare/claim-status-codes and are to be reflected in the X12 277 transactions issued on and after the date of implementation of CR 8265 (July 1, 2013).http://www.wpc- edi.com/reference/codelists/healthcare/claim-status-category-codes/ http://www.wpc- edi.com/reference/codelists/healthcare/claim-status-codes

10. 2013 Updated Rules Effecting Billing GPNet Communications Due to a technical issue, a name change is required for the ASC X12 999 being placed in GPNet mailboxes. Effective May 18, 2013, the new naming convention will be 999nnnnn.999 (where nnnnn represents a sequential number). Older 999s generated prior to May 18, 2013 will not be affected by this change. The GPNet Communications Manual includes information about Palmetto GBA's EDI Gateway. To view the GPNet Communications Manual, select the PDF link below. http://www.palmettogba.com/Palmetto/Providers.nsf/files/EDI_GPNet_Comm.pdf/$ FIle/EDI_GPNet_Comm.pdf

11. 2013 Updated Rules Effecting Billing HIPAA Eligibility Transaction System (HETS) HETS 270/271 will be replacing the Common Working File (CWF) HETS is intended to allow the release of eligibility data much like the CWF CMS also is currently pilot testing an internet-based User Interface (UI) System (HETS UI). HETS is Extranet-based X12N 270/271 Eligibility System The HETS 270/271 application supports real-time transactions only An IP connection can be obtained from an authorized Network Service Vendors HETS Companion Guide http://www.cms.gov/Research-Statistics-Data-and-Systems/CMS-Information- Technology/HETSHelp/Downloads/HETS270271CompanionGuide5010.pdf HETS User Guide https://www.cms.gov/Research-Statistics-Data-and-Systems/CMS-Information- Technology/HETSHelp/Downloads/HETS-UI-User-Guide.pdf

12. 2013 Updated Rules Effecting Billing Consolidated Billing Medicare payment for services subject to home health consolidated billing is made to the primary HHA The primary HHA is responsible for providing these services/supplies, either directly or under arrangement A HHA would not be responsible for payment to another provider in the situation in which they have no prior knowledge of physicians orders of the services provided during an episode In certain circumstances where the primary HHA is unaware of services provided during the episode and the beneficiary is properly notified, the beneficiary may be liable for payment Notification about home health consolidated billing must begin with the beneficiary’s admission to home health care http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c10.pdf

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