Posts Tagged ‘HIPPS’

Medicare Advantage HIPPS Code Requirement Delayed

July 1, 2013

CMS has confirmed that the edit to reject Medicare Advantage plan claims for not having a HIPPS code for home health services will not be activated until December 1, 2013. Therefore, the MA plans and the HHAs have until that time to make the necessary system adjustments to place a HIPPS code on MA claims.

In addition, CMS has instructed the MA plans to communicate the HIPPS code requirements with HH providers so that they are able to make any changes to their systems. Agencies should contact their contracted MA plans for further instructions in complying with this requirement.  

Update on HIPPS Codes on MA Plan Claims

June 24, 2013

In a conference call with CMS officials earlier this week, the National Association for Home Care & Hospcie learned that although the Medicare Advantage plans have been instructed to include a HIPPS codes on claims effective July 1, 2013, the edits for this requirement will not be turned on until sometime in September. CMS will get back to NAHC with a firm date as to when exactly. At least for the short term there will be no payment consequence for MA plans that do not submit a HIPPS code for home health services, and therefore home health claims should not be held up either.

CMS expects the HIPPS code to be entered on claims the same as with Fee for Service Medicare. We do urge the providers and their vendors to begin the necessary changes to their software systems to be ready for when the firm compliance date is announced. We also urge you to contact your health plans to determine what specifically they are, or are not, requiring related to including the HIPPS code on claims.

We are seeking feedback on whether agencies and vendors can alter their systems in time for September.

CMS is Requiring HIPPS Codes on Medicare Advantage Claims

June 19, 2013

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. (more…)

Palmetto GBA: HIPPS Codes 2CGK* & 1BGP* in Four Regions Medical Review Results

June 19, 2013

The J11 Medical Review Department performed a service-specific prepay targeted medical review on claims for 2CGK* and 1BGP* (variable last digit of HIPPS codes). These edits were set for four regions within the J11 Home Health jurisdiction:

  • Midwest (including IL, IN and OH)
  • Southeast (KY, NC, SC and TN)
  • Southwest (AR, LA, NM, OK and TX)
  • Gulf Coast (AL, FL, GA and MS).

These results are for¬†claims processed February through April 2013. (more…)

Palmetto GBA: Service Specific Probe Review for Select HIPPS Codes

February 7, 2013

The J11 A/B MAC Medical Review department will perform a service-specific prepay complex review on claims billed for selected Home Health HIPPS codes.

The Medical Review department identified the top 20 Home Health HIPPS codes, ranked by provider disbursement. Information was contained within the reports regarding the number of claims medically reviewed, and the number of claims that contained a medical review denial. Further analysis determined a claim count denial rate for each of these HIPPS codes. (more…)

Palmetto GBA Announces Service Specific Probe Review for Select HIPPS Codes

January 25, 2013

Palmetto GBA announced yesterday that the J11 A/B MAC Medical Review department will perform a service-specific prepay complex review on claims billed for selected Home Health HIPPS codes.

The Medical Review department identified the top 20 Home Health HIPPS codes, ranked by provider disbursement. Information was contained within the reports regarding the number of claims medically reviewed, and the number of claims that contained a medical review denial. Further analysis determined a claim count denial rate for each of these HIPPS codes. (more…)

The 2012 HHRG to HIPPS Calculator is Here!

December 16, 2011

For those of you that are familiar with the HHRG to HIPPS calculator, you already know what a valuable tool this spreadsheet is. Thanks to HCAF Board member Melinda Gaboury, CEO of Healthcare Provider Solutions, Inc. we now have the 2012 version available on our website. (more…)