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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
- 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)
- Impact of an Inpatient Admission During an HH PPS Episode
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.
- Attending Physician Editing – Change Request (CR)
6856 expands editing to verify that the attending physician’s National
Provider Identifier (NPI) is valid, and to ensure that the attending
physician is enrolled in Medicare and is in Medicare’s Provider Enrollment,
Change and Ownership System (PECOS). The Centers for Medicare & Medicaid
Services (CMS) has a PECOS
Monthly Ordering and Referring report
available that contains the NPI for all physicians who are of a type/specialty
that are eligible to order and refer beneficiaries for home health services.
For additional information refer to the Medicare Learning Network (MLN)
Matters® article MM6856.
-
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 — Section 6404 of the Patient
Protection and Affordable Care Act (PPACA) amended the timely filing
requirements to reduce the maximum time period for submission of all
Medicare claims to one calendar year after the date of service. For
additional information, refer to Change Request 6960 — Systems Changes Necessary
to Implement the Patient Protection and Affordable Care Act (PPACA)
Section 6404 - Maximum Period for Submission of Medicare Claims Reduced
to Not More Than 12 Months.
- 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: June 10, 2010
