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J15 HH&H FAQs

WebWith a multiple page document, each page should be identified as being part of the entire document. For example; page 1 of 4, page 2 of 4, page 3 of 4 and page 4 of 4. The …

Actived: 9 days ago

URL: https://www.cgsmedicare.com/medicare_dynamic/faqs/faqshhh/display_faqs_j15HHH.aspx?id=116

Primary Home Health Diagnosis Codes Grouper Update for April 1, …

WebThe CY 2023 Final Home Health Clinical Group and Comorbidity Adjustment Diagnosis List provides the clinical grouping of HH diagnosis codes, and all codes …

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DOCUMENTATION CHECKLIST TOOL

WebDo the following data elements match the claim and OASIS assessment: Home health agency (HHA) Certification Number (OASIS item M0010) Beneficiary Medicare Number …

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FACE-TO-FACE (FTF) Encounters for Home Health Certification

WebFTF must occur no earlier than 90 days prior to the start of care (SOC) or within 30 days after the SOC. If the FTF encounter occurred within 90 days of the SOC but is not related …

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Interactive Medicare Electronic Remittance Advice (ERA)

WebInteractive Medicare Electronic Remittance Advice (ERA) The Medicare Electronic Remittance Advice (ERA) is a notice sent to home health and hospice …

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Physician or Allowed Practitioner Orders, Plan of Care and …

WebThree basic requirements for ordering services are: The physician or allowed practitioner must be enrolled in Medicare; The ordering National Provider Identifier (NPI) …

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January 2024 HCPCS Updates – New, Revised, and Discontinued …

WebThis following list contains added HCPCS codes that will be effective in January 2024. HCPCS. DESCRIPTION. Effective Date. A4287. Disposable collection …

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CGS Overview: Home Health Patient-Driven Groupings Model …

WebAfter January 1, 2020, under the Patient-Driven Payment Model, a case-mix adjusted payment for a 30 day period of care is made using one of 432 home health …

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Signature Guidelines

WebSignature Guidelines. The Centers for Medicare & Medicaid Services (CMS) issued Change Request (CR) 6698 to clarify for providers how Medicare contractors …

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Reason Code Descriptions and Resolutions

WebThis reason code is assigned because the Value Code 85 and the Federal Information Processing Standards (FIPS) state and county code, is missing or invalid. …

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Home Health Documentation Checklist Tool (Home Health

WebDo the following data elements match the claim and OASIS assessment: Home health agency (HHA) Certification Number (OASIS item M0010) Beneficiary Medicare Number …

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Standard Companion Guide Health Care Claim Professional …

WebThis CG also applies to ASC X12N 837P transactions that are being exchanged with Medicare by third parties, such as clearinghouses, billing services or network service …

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Advance Beneficiary Notice (ABN) vs.

WebAdvance Beneficiary Notice (ABN) vs. - CGS Medicare

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60-day Episode Calendar Schedule

WebThe “Statement Covers Through” date (UB-04 Form Locator 6) on Home Health Prospective Payment System (HH PPS) claims should reflect the 60th day of the …

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Annual Wellness Visit (A/B MAC Jurisdiction 15)

WebFirst annual wellness visit providing personalized prevention plan services means the following services furnished to an eligible beneficiary by a health professional that …

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Reason Code Search and Resolution Tool

WebThe Reason Code Search and Resolution tool allows you to view a reason code description and determine how to prevent/resolve the edit. You may search by …

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Resolving Rejected Home Health Claims Caused by Billing Errors

WebResolving Rejected Home Health Claims Caused by Billing Errors. Home health claims most often reject because the claim is a duplicate of one already …

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Denial Reason 5HH01: Homebound Status Is Not Supported …

WebThe homebound status must be documented in the medical record frequently enough to reflect the patient’s current functional status, and at a minimum, at …

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Medicare Secondary Payer BILLING & ADJUSTMENTS

WebEnter payer code “C” if primary insurer payment denied or applied to deductible. Enter payer code “Z” on line B. NOTE: Value Code 44 should not be reported …

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