HIPPS Codes Must Soon Match OASIS Codes

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By Terry Miller, RN, COS-C 
Regulatory Advisor, McKesson

HIPPS Codes Must Soon Match OASIS CodesA close examination of your home health agency’s billing procedures is in order if you are receiving warning messages that your HIPPS codes don’t match your OASIS codes. Those warning messages could turn into reimbursement denials starting July 1, 2014.

CMS issued Change Request 7760 in part to fix a vulnerability that could lead to improper overpayments, an issue that the Office of Inspector General has noted. Home health agencies – along with skilled nursing facilities and inpatient rehab facilities – submit individual patient assessments from their home health software into a standard transmission format that’s sent to the state survey agency or a national repository. The same information is used to generate a case-mix group used on Medicare Prospective Payment System claims via the Health Insurance Prospective Payment System (HIPPS) code.

But the transmission of assessment data and transmission of HIPPS codes to Medicare administrative contractors are separate processes, which creates the potential for improper claims submissions because the HIPPS code cannot be validated against the treatment assessment.

CR 7760 will help verify the HIPPS code on the claim is consistent with the CMS’ OASIS submission system calculation. In those cases where the codes do not match, it is the agency’s responsibility to confirm the HIPPS code from the Final Validation Report is the code reported on the bill.

McKesson Homecare™ has been updated to accommodate the changes needed to comply with CR 7760. A new option to the OASIS Assessment report shows those files where current and extracted HIPPS codes do not match, enabling you to view changed assessments that you need to extract and resubmit.

The Billing Advisory Report in McKesson Homecare also was updated to accommodate HIPPS codes that changed since bill posting, as well as mismatched Request for Anticipated Payment (RAP) and final claim HIPPS codes.

Your billing staff needs to be aware of these upcoming changes so Medicare reimbursements do not become interrupted.

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