CMS is Requiring HIPPS Codes on Medicare Advantage Claims

Effective July 1, 2013 home health agencies will be required to include a Health Insurance Prospective Payment System (HIPPS) code on Medicare Advantage claims. The Centers for Medicare & Medicaid Services has instructed MA organizations to reject any home health claim that does not include a HIPPS code. According to a CMS communication with the health plans, CMS is requiring the HIPPS codes on home health claims in order to accurately price home health encounters.

CMS has not provided any direct communication with the provider community. Several agencies have been informed of this requirement through communications from their contracted MA plans. However, many agencies have not received any communication.

There are several significant logistical problems that agencies will have in order to comply with this requirement, particularly agencies that are reimbursed on a per visit basis by the health plan. Agencies will need some lead time to alter their software systems to accommodate the per-visit contracts.Additionally, specific changes that need to be made to software systems are unclear.

NAHC is seeking clarification from CMS and will continue to advocate for the home health industry regarding this new requirement.

In the meantime, agencies should contact their health plans to seek information and instructions.

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