Home Health Training: Expert Tips on Troubleshooting Your NRS Billing Processes

On troubleshooting the payment variances, absolutely it is essential that any of you responsible for that kind of work to definitely be current on billing codes in how to read those and interpret those. Get the skinny on the NRS billing process these expert information provided by our expert in a home health conference.

What are the most recent claims processing issues? Making sure that we're verifying up the timing against common working file, making sure we have billed the correct number of therapy visits and being able to verify the HIPPS code and the OASIS matching string billed compared to what was paid. Those are the steps we absolutely got to be comfortable in this doing.

Well, as of the timing issues, final claim have correctly been billed as late but incorrectly paid as early. That is an issue that has persisted up until July the 7th. So what happened was claims processing edits were only reading common working file episodes on file as of January the 1st. So if you had an episode that should have been late because it had adjacent episodes that were prior to January 1, then your final claim probably has been recoded and incorrectly paid as early instead of late which would actually result in an underpayment.

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So on July the 7th, there was a claims processing edit put in place to prevent that error from continuing. But of course we have over seven months of claims where that had actually occurred. CMS has not released information when those claims paid in error will get reprocessed. Hopefully within the month or so, that's just my best guess there will be a new transmittal that will outline when those reprocessing will take effect. So be sure to watch all of the Medicare communications so that you do not miss out on when that's going to occur.

Now, on routine supply issues, there have also been payment errors that occurred for episodes that began in 2007 that ended in 2008. Those episodes were overpaid by $14.12 which is the lowest severity level of the non-routine supply payment add-on.

Now, not all of your episodes would have been processed with that payment error. Probably it should have just been those claims that were billed in the first two months of PPS refinements because it was around that time that that edit was fixed.

But also with a non-routine supply issues, we have billing process changes so that when final claims that are billed with the HIPPS in an alphabetic character, that's only appropriate if there were no supplies provided during the episode. So final claims that did not have supplies provided those need to be billed using the corresponding number in that 5th position of the HIPPS code.

So essentially on a HIPPS code, the rest will always end in SPUVW or X. But on your final claim, that that HIPPS code, that position needs to be changed to 1, 2, 3, 4, 5 or 6 but only if no non-routine supplies were provided during the episode. So it's really not appropriate to just change that code simply because you don’t see any supplies on the claim, our expert says in the home health conference.

As the healthcare guidelines require, you need to have a process where you can verify there are no supplies on the claim because no supplies were provided and not just because supplies somehow did not get captured in your charge batch or on your final claim. So non-routine supplies, those would be billed using revenue 0270 or you can use 0623 specifically for wound care supplies if you choose to do so.

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