Effective July 1, 2013, home health agencies will be required to include a Health Insurance Prospective Payment System (HIPPS) code on all Medicare Advantage claims. The Centers for Medicare & Medicaid Services (CMS) has instructed Medicare Advantage organizations to reject any home healthcare claim that does not include a HIPPS code. CMS has not directly communicated this requirement to home health agencies; however, 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.
Several agencies have been informed of this requirement through communications from their contracted Medicare Advantage plans.
There are several logistical problems that agencies will have to overcome 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, but many vendors are making adjustments to include the HIPPS code field.
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 and to clarify any questions.
The new requirement hasnt been announced to the provider community, but was shared by CMS in a presentation to one of its user groups.