The Centers for Medicare & Medicaid Services (CMS) has issued an important update, Change Request (CR) 13225, set to take effect on January 1, 2024. This update aims to enhance the accuracy and efficiency of processing home health (HH) claims. Here’s what you need to know:

1. Removal of the Edit Bypass for Condition Code DR

CMS has removed the edit bypass that previously allowed home health claims with condition code DR to process without a matching patient assessment. Moving forward, claims reporting condition code DR must either correct the occurrence code 50 date or remove it if submitted in error. This change ensures that only accurate and validated claims are processed, reducing errors and improving overall claims accuracy.

2. Preservation of Medical Review Information

The new guidelines ensure that medical review data is retained even if a reviewed claim later encounters an admission source edit. This is a crucial step in preventing unnecessary rework and avoiding additional requests for records from providers, which can delay claim processing and impact payment timelines.

3. Timely Submission of Notices of Admission (NOA)

Home Health Agencies (HHAs) are now required to submit Notices of Admission (NOAs) within five calendar days of a patient’s admission to avoid payment reductions. While exceptions are allowed under certain circumstances, such as natural disasters or system issues, it is essential for HHAs to adhere to this timeline to ensure full payment.