| Subject |
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| Category |
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| What is the billing process for patients receiving both outpatient therapy and home health services? |
Prospective Payment System (PPS) |
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| Are nurse practitioner visits (physician office and wound care centers) part of the bundled PPS episode payment to HHAs? |
Prospective Payment System (PPS) |
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| If a patient (under a home health plan of care) is seen in an outpatient therapy clinic, does the clinic bill the HHA? |
Prospective Payment System (PPS) |
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| Where is the policy that holds that 'wound care must be efficacious', as well as finite and predictable to be covered? |
Prospective Payment System (PPS) |
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| Please provide a comprehensive listing of home health services for which HHAs are responsible. |
Prospective Payment System (PPS) |
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| Please define “covered and paid for” non-routine medical supplies for which the home health agency is now responsible? |
Prospective Payment System (PPS) |
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| If a patient, is hospitalized during their 60 day Home Health Certification & Plan of Care (form CMS 485) is a 2nd 485 required? |
Prospective Payment System (PPS) |
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| What is the definition of SCIC? Is a physician change order needed to start a new HHRG? |
Prospective Payment System (PPS) |
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| When dates outside of the 5-day window occur, will RAPs and claims be rejected? What, if anything, would happen? |
Prospective Payment System (PPS) |
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| What are HHA’s responsibilities for outpatient services? When are they accountable for denials of coverage? |
Prospective Payment System (PPS) |
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| What are a HHA’s responsibilities for providing medical supplies, even if unrelated to plan of care. |
Prospective Payment System (PPS) |
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| How do DME and medical suppliers know when a beneficiary is under the care of a HHA? Will they be denied payment? |
Prospective Payment System (PPS) |
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| Are HHAs required to provide all diabetic supplies for patients under a home health plan of care? Is payment bundled? |
Prospective Payment System (PPS) |
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| What is the HHA’s responsibility for providing medical supplies to home health patients without Medicare B coverage. |
Prospective Payment System (PPS) |
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| Are HHAs required to provide all supplies for IV infusions for patients under a HH plan of care? Is payment bundled? |
Prospective Payment System (PPS) |
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| Is the agency responsible for all diabetes-related supplies if the patient has primary/secondary diagnoses of diabetes? |
Prospective Payment System (PPS) |
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| Is a SCIC adjustment necessary if an additional therapy visit is needed than was expected at the start of care? |
Prospective Payment System (PPS) |
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| If the patient purchases supplies from a DME vendor, are HHAs responsible for payment to vendors? |
Prospective Payment System (PPS) |
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| Please discuss/explain the unbundling of diabetic patient supplies. |
Prospective Payment System (PPS) |
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| Please clarify the SCIC adjustment refinement policy. |
Prospective Payment System (PPS) |
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| A discharged patient (goals met) is readmitted w/ an exacerbation of the same diagnosis; is this a new/original episode? |
Prospective Payment System (PPS) |
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| Clarification of HH visits with inpatient admission and discharge dates, coverage of patient’s visit on date of death. |
Prospective Payment System (PPS) |
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| If a wound center bills Part B for supplies for a patient under HH POC, would the wound center be denied? |
Prospective Payment System (PPS) |
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| What happens when a patient is admitted and has a change in condition 2 days later? Is a SCIC completed? |
Prospective Payment System (PPS) |
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| Must the verbal order for the RAP be written and sent to the physician or does it need to be signed before submission? |
Prospective Payment System (PPS) |
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| How does CMS define “incontinence supplies”, what is included under this code, and where can HHAs find coverage info? |
Prospective Payment System (PPS) |
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| If a patient (under a POC) goes to a doctor’s office to change the wound dressing, how does the doctor bill supplies? |
Prospective Payment System (PPS) |
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| How will payment be made if a SCIC occurs on a home visit during which the OASIS is completed and treatment initiated? |
Prospective Payment System (PPS) |
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| Is a one time nursing visit now allowable if the patient is under a qualifying plan of care (POC) for physical therapy (PT)? |
Prospective Payment System (PPS) |
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| If a patient buys supplies and then requires HH services for a period of time, when is the HHA responsible for supplies? |
Prospective Payment System (PPS) |
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| Are HHAs required to provide ostomy supplies to ostomic patients who are admitted for conditions unrelated to ostomies? |
Prospective Payment System (PPS) |
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| What type of adjustment applies if a patient is re-admitted to the same HHA with an exacerbation of the same condition? |
Prospective Payment System (PPS) |
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| Can HHA Primary Diagnoses be used as Secondary Diagnoses? |
Prospective Payment System (PPS) |
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| How will medical supply costs be included into the outlier payment and at what rate? Part B allowable? |
Prospective Payment System (PPS) |
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| Are insulin syringes excluded from the bundled requirement as lancets and test strips are? |
Prospective Payment System (PPS) |
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| What rule changes to make HHA responsible for other supplies used by the patient outside the actual visit? |
Prospective Payment System (PPS) |
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| What happens to recertification if a patient transfers to a hospital without HHA discharge and then resumes HH care? |
Prospective Payment System (PPS) |
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| When is the HHA financially responsible for Part B supplies and services? |
Prospective Payment System (PPS) |
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| If a patient has a closed healed, surgical wound, do you still consider it a 'wound' on the OASIS assessment? |
Prospective Payment System (PPS) |
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| What can HHAs do if the patient’s actual therapy utilization is above or below the threshold appropriate to the HIPPS code? |
Prospective Payment System (PPS) |
