The Centers for Medicare & Medicaid Services (CMS) has issued a new Change Request (CR) 13225, effective January 1, 2024, aimed at refining the processing of home health (HH) claims. This update focuses on improving the accuracy and efficiency of claims reporting condition code DR and handling admission source edits.

Key Changes:

1. Removal of Edit Bypass: The update eliminates the bypass edit that previously allowed HH claims with condition code DR to be processed without a matching patient assessment. Now, claims reporting condition code DR must either remove the occurrence code 50 if submitted in error or correct the date to ensure accuracy.
2. Medical Review Information Retention: The new guidelines ensure that medical review information is preserved even if a reviewed claim later receives an admission source edit, preventing unnecessary rework and requests for additional records from providers.
3. Timely Submission of Notices of Admission (NOA): HHAs must submit NOAs within five calendar days of admission to avoid payment reductions. Exceptions are allowed under certain circumstances, such as natural disasters or system issues.