Home Health Claims Filing
The Fiscal Intermediary Standard System (FISS) Claims/Attachments option (FISS Main Menu option 02) allows you to enter home health Requests for Anticipated Payments (RAPs) and final claims. The following provides screen prints and field descriptions for each FISS claim page and identifies which fields are required for RAPs, final claims, and home health outpatient claims. Information is also provided about specials claims filing situations. For more information about FISS, refer to the FISS Reference Guide.
Go to the Home Health Prospective Payment System (HH PPS) Web page for an overview of HH PPS.
There are six claim pages within FISS:
Special Claims Filing Situations
- Beneficiary Elected Home Health Transfer
- Home Health Discharge/Readmit
- Billing Osteoporosis Drugs for Home Health Beneficiaries
- Billing Vaccination Claims
- Billing Individual Influenza and Pneumococcal Pneumonia Vaccines
- Roster Billing for Mass Influenza and Pneumococcal Pneumonia Vaccines
- Correcting Home Health Episode Information Posted to the Common Working File (CWF)
- Demand Denials (Condition Code 20)
- HH PPS Claims With Non-Routine Supplies (NRS)
- Home Health Outpatient Therapy Billing
- Newly Certified Home Health Provider or Provider Number Change
- No-Payment Billing (Condition Code 21)
- Overlapping HH PPS Episodes due to a Hospital Admission
Additional Resources:
-
Claims Main Web Page – The Claims Web page provides a variety of resources related to filing, correcting, adjusting, and the processing of Medicare claims, additional development requests (ADRs), credit balance reports, reference tools, claims submission errors, common questions, and payment information.
-
Consolidated Billing Master Supply List
– This list is maintained and
updated annually by the Centers for Medicare & Medicaid Services
(CMS) and contains the nonroutine supplies that are included in consolidated
billing under the Home Health Prospective Payment System (HH PPS - Timely
Filing Requirements — Medicare Claims Processing Manual (CMS
Pub 100-04, Ch. 1, §70) — Chapter 1 explains that
all Medicare billing transactions for services provided in the first
three quarters of a calendar year (Jan. – Sept.) are considered
timely if received by December 31 of the year following the service
year. Billing transactions provided in the fourth quarter (Oct. – Dec.)
have an additional year.
-
Medicare Claims Processing Manual (CMS Pub. 100-04, Ch. 10)
-
Chapter 10 of the Medicare Claims Processing Manual describes bill
processing requirements that are applicable only to home health agencies. - Medicare
Claims Processing Manual (CMS Pub. 100-04, Ch. 25) -
Refer to Chapter 25 for a complete description of all the items included
on the CMS-1450 (UB-04) claim form.
- Home Health Quick Reference Tools - A variety of tools developed by the Cahaba’s Provider Outreach and Education staff are available to assist in the successful processing of your claims.
Page last updated: November 13, 2009
