The Centers for Medicare & Medicaid Services (CMS) has delayed, once again, the edit to reject Medicare Advantage (MA) plan claims that do not have a health insurance prospective payment system (HIPPS) code for home health services. The edits will not be activated until July 1, 2014. MA plans and the HHAs have until that time to make the necessary system adjustments.
CMS initially intended to require that MA plans include a HIPPS code on all home health encounters beginning July 1, 2013. The National Association for Home Care & Hospice (NAHC) contacted CMS in June to discuss concerns regarding the failure of the health plans to communicate this directive with the provider community. Several weeks after our call, CMS announced that were delaying the edit until December 1, 2013.
In a letter to the MA plans, CMS again announced delaying the edit for HIPPS codes on home health and skilled nursing facility encounters until July 1, 2014.
The letter states: “MAOs and other entities were instructed that effective December 1, 2013 dates of service (DOS), the disposition for the HIPPS codes edits would be changed from ‘Informational’ to ‘Reject’ for any Skilled Nursing Facility (SNF) and Home Health (HH) encounters submitted without the appropriate HIPPS codes. The purpose of this notification is to let you know that the December 1, 2013 DOS ‘Reject’ edit will be delayed to July 1, 2014 DOS. The ‘Informational’ edit for HIPPS codes would remain in place until that time.”