Medicare has announced that as of 7/1/2013, in PPS billing they want to capture the location where the home health services are performed using HCPCS codes Q5001, Q5002, Q5009. As we read the requirements, we understand them to mean that the reporting will not be the same as one thinks of with Hospice (each visit has an associated HCPCS code noting the place of service). Instead, they want an additional visit/revenue line added to the invoice for the same date as the very first billable visit using the same revenue code as the first billable visit. This additional revenue line will also contain the HCPCS code for the place of service with the billing amount being $.01. If the location of service changes during the episode, another revenue line for $.01 will be added with a new HCPCS code. It should have the same date as one of the visits during the episode. It appears that this change applies only to final claims.
Instead of requiring agencies to enter extra visits or other information for this purpose in the visit screens, we plan to add additional fields in the PPS Billing Information screen. One field will be an initial place of service HCPCS code. The system will automatically create the first visit additional revenue line on the invoice from this field. Our current thoughts are that if the field is left blank at the time of the claim submission, we will populate the new field with Q5001 = patient’s home/residence which will minimize claim rejections. It will be the users responsibility to correct the information if Q5001 is incorrect. A couple of extra date and HCPCS code combination fields (probably 2 or 3 sets) will be added in order to let you record changes in the place of service. Dates entered in these fields will need to match actual visit dates for the patient. The system will create additional revenue lines on the invoice if information is entered into these fields. We felt this approach would be easier than trying to record something in visit screens, which would increase the chances of incorrect historical visit counts etc.
The new fields will probably appear in the PPS Billing Information screen sometime in the next couple of weeks. Sometime around April we will modify the software to become effective as of July 1st, 2013 with the user not really seeing any changes. We do not see this is a major programming change. Beginning July 1st, 2013, HHC3000 users will just need to make sure Q5001 is appropriate for the first visit and then record any changes in location of service during the episode in the new fields.
Finally, there is a requirement that any visits that are additional visits from the original plan of care need to have a modifier code. There is already a field in the patient visits screen for modifier codes that can be used for this purpose.