Home Health Claims Selected for Review with Dates of Service Oct. 1, 2011 through Dec. 31, 2012

CMS issued V3210 and V3312 of the Home Health Prospective Payment System (HH PPS) Grouper effective for dates of service October 1, 2011 and later. V3210 and V3312 did not award points for basal and squamous cell carcinoma for home health services. CMS has reexamined the decision to only award points to code category “173” codes containing a 5th digit of 9. In V3413, CMS has added basal, squamous and unspecified malignant cancers retroactive to October 1, 2011. Effective, January 1, 2013 for dates on or after October 1, 2011, the HH PPS Grouper will award points for the entire 173 code category.

Home Health agencies may want to review any claims with dates of service submitted from October 1, 2011 through December 31, 2012 to make a business decision as to whether or not to adjust the claim based upon a different Health Insurance Prospective Payment System (HIPPS) score determination made by V3413 of the HH PPS Grouper.

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, 2012 that contain a diagnosis for basal or squamous cell skin cancer.

Administrative error exceptions will apply to the timely filing limit to claims adjustments received up to one month following the date a provider is notified of this correction. Timely filing exceptions will apply to adjustments to HH PPS episode claims with statement covers “From” dates between October 1, 2011 and a year before the date the provider education is released.

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