by Jared Staheli
June 18th, 2015
Section 1842 (b)(6)(F) of the Social Security Act requires consolidated billing of all home health services while a beneficiary is under a home health plan of care authorized by a physician. Consequently, Medicare makes payment for all such items and services to a single home health agency (HHA) overseeing that plan.
The law states payment will be made to the HHA without regard as to whether or not the item or service was furnished by the agency, by others under arrangement to the HHA, or when any other contracting or consulting arrangements exist with the primary HHA, or “otherwise.” Payment for all items is included in the home health prospective payment system (HH PPS) episode payment the HHA receives.
Nonroutine medical supplies are among the types of services that are subject to the home health consolidated billing provision. Medicare periodically publishes Recurring Update Notifications that contain updated lists of nonroutine supply codes that must be included in home health consolidated billing. These services may not be billed separately by a DMEPOS supplier when a Medicare beneficiary is in a HH PPS episode of care.
Durable Medical Equipment (DME), including prosthetics, orthotics and oxygen, is exempt from home health consolidated billing by law.
For detailed information regarding home health consolidated billing, DMEPOS suppliers should refer to chapter 10, section 20 of this manual.