Home Health Claims Selected for Review with Dates of Service October 1, 2011 Through December 31, 2011

CMS issued V3210 of the home health prospective payment system (PPS) Grouper effective for dates of service October 1, 2011 and later. New Diagnosis codes 294.20 and 294.21 were not initially approved for addition to the V3210 of the HH PPS Grouper. In V3312, CMS has added these two diagnosis codes for dates of service October 1, 2011 and later. V3312 of the HH PPS Grouper which is effective January 1, 2012 will update the HH PPS Grouper so that OASIS records submitted with these diagnosis codes will result in the HH PPS Grouper producing the appropriate set of scores and HIPPS code for dates of service October 1, 2011 and later.

Regional Home Health Intermediaries (RHHIs) have received technical direction from CMS that provides the necessary information for their use in reviewing home health claims with a date of service between October 1, 2011 and December 31, 2011 that contain diagnosis codes 294.20 and 294.21.

Home health agencies may want to review any claims with dates of service submitted from October 1, 2011 through December 31, 2011 to make a business decision as to whether or not to adjust the claim based upon a different HIPPS score determination made by V3312 of the HH PPS Grouper.

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