Home Health|Hospice Articles and Resources
News and Important InformationPDGM Calculator for Home Health: Reminder, CMS has changed the unit of the home health payment from a 60-day episode to a 30-day period. When using the calculator, be sure that you enter the “Number of Visits” based on 30 days instead of 60 days. Read the entire article. Definition and Uses of Health Insurance Prospective Payment System Codes (HIPPS Codes) Code SetsCPT CodesCPT Procedure Codes ICD-10-CM CodesICD-10-CM Diagnosis Codes Find-A-Code's Tools & ResourcesClick-A-Dex™Click-A-Dex™ Index Search Tool Build-A-CodeStep-by-step coding from all major code sets. NCCI Edits ValidatorValidate using NCCI edits for errors in code selection. Pro-Fee CalculatorVerify Medicare Reimbursement and UCR Fees for Professional Services Commercial Payer PoliciesView Clinical Indications for Medical necessity on procedures, Suggested Code Selection to assist your clinical judgment includes citations. Find-A-NPI™Find-A-NPI™ Fast Provider Lookup HIPPS (PDGM/HIPPS) CalculatorUse this calculator to find a HIPPS code and estimated payment based on the Home Health PDGM Additional Links and ResourcesMedicare Home Health BenefitMedicare Home Health Benefit MLN CatalogBrief descriptions and links to trusted MLN educational resources. Patient Driven Groupings Model (PDGM), eff 01/01/2020Wage index, Case Mix and Rural add-ons Home Health Agency BillingCh. 10 Medicare Claims Processing Manual Drugs and Biologicals Pub-100 Ch 17Drugs and Biologicals Pub-100 Ch 17 Billing Requirements for OPPSBilling Requirements for OPPS Providers with Multiple Service Locations CMS PUB 100-04: Transmittal 4378Home Health (HH) Patient-Driven Groupings Model (PDGM) - Revised and Additional Manual Instructions ImplementationMLN Matters: MM11081 Home Health (HH) Patient-Driven Groupings Model (PDGM)Revised and Additional Manual Instructions MLN MM11395 Medicare Benefit Policy ManualChapter 7 - Home Health Services Home Health Medicare Billing Codes SheetCGS - Home Health Medicare Billing Codes Sheet PDPM Fact SheetsMLN PDPM Fact Sheets and Related Topics NAHCNational Association for Home Care & Hospice PDGM EducationPatient-Driven Grouping Model (PDGM) Education Standard Written Order (SWO)Dates of Service on or After January 1, 2020 Ch. 4 Claims and Attachments MenuFiscal Intermediary Standard System (FISS) Direct Data Entry (DDE) Guide CDE'sCMS- Clinical Data Elements Select the title to see a summary and a link to the full article. October 28th, 2020 Incident To| Published October 28th, 2020
Just about any large clinic you visit will have non-physician practitioners, or NPPs. These will include physician assistants, nurse practitioners, and clinical nurses for example. Practices and clinics can bill under the NPPs if they are credentialed with the payer, but the reimbursement is only 85% of the fee schedule. There ... October 1st, 2020 New Codes for Cytokine Release Syndrome (CRS)| Published October 1st, 2020 - Last Review/Update October 6th, 2020 New codes for Cytokine Release Syndrome (CRS) are effective October 1, 2020 based on the grade/severity of the symptoms. This article covers the new grading scales. August 28th, 2020 New Value-Based Payment Models for Primary Care (Primary Care First and Direct Contracting)| Published August 28th, 2020 This article summarizes the new Medicare value-based payment models: Primary Care First and Direct Contracting. August 10th, 2020 Modifier 50 — Four "Must Know" Tips For Getting Paid| Published August 10th, 2020 Modifiers added to an HCPCS or CPT© code alters the code description, providing clarity about the service for proper claim processing and reimbursement. Here are four things you must know about modifier 50 to ensure proper payment. - Modifiers are either informational or payment related. Informational modifiers provide additional... July 20th, 2020 New Grouper Added for Skilled Nursing| Published July 20th, 2020
The additional grouper for Skilled Nursing, sometimes referred to as (PDPM), is used for classifying SNF patients in a covered Part A stay.
This grouper is included with our Home Health Grouper.
Current groupers/calculators include:
Home Health PDGM (Patient-Driven Grouping Model)
Skilled Nursing Facility PDPM (Patient-Driven Payment Model)
What is it?
According to CMS, In ... July 14th, 2020 Are NCCI Edits and Modifiers Just for Medicare?| Published July 14th, 2020 The National Correct Coding Initiative (NCCI) edits were developed by CMS to help promote proper coding and control improper coding that leads to incorrect payments with part B claims. It is important to understand that NCCI edits do not include every possible code combination or every type of un-bundling combination. With that ... April 15th, 2020 New CPT® Codes Approved for COVID-19 Antibody Identification| Published April 15th, 2020 On April 10, 2020, the American Medical Association approved and published a revision of code 86318 and added two new codes 86328 and 86769 for reporting Coronavirus [COVID-19] antibody testing. March 31st, 2020 CMS-Coverage for Therapeutic Shoes for Individuals with Diabetes| Published March 31st, 2020 Therapeutic shoes and inserts can play a vital role in a diabetic patient's health. Medicare may cover one pair every year and three pairs of custom inserts each calendar year if the patient qualifies and everything is handled correctly. Medicare Benefit Policy Manual explains what is needed for a person with diabetes to ... March 5th, 2020 Who Qualifies for Chronic Care Management Services| Published March 5th, 2020 Per MLN Chronic Care Management Services, the following patients are eligible: "Patients with multiple (two or more) chronic conditions expected to last at least 12 months or until the death of the patient, and that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline, are eligible for CCM services."
Examples of chronic conditions ... December 4th, 2019 Preview the PDGM Calculator (HIPPS calculator) for Home Health Today| Published December 4th, 2019 Find-A-Code's Patient-Driven Groupings Model (PDGM) home health payment calculator (HIPPS Calculator) simplifies payment calculations. See https://www.findacode.com/tools/home-health/ . November 25th, 2019 New Medicare Home Health Care Payment Grouper — Are You Ready?| Published November 25th, 2019 In 2020, Medicare will begin using a new Patient-Driven Groupings Model (PDGM) for calculating Medicare payment for home health care services. This is probably the biggest change to affect home health care since 2000. August 16th, 2019 Medical ID Theft| Published August 16th, 2019 - Last Review/Update August 20th, 2019 Medical ID Theft
"So, do you guys think you can do something with that?" John asked angrily at our first meeting with him in August 2017 as he slammed a stack of medical bills, EOBs and collection letters - three inches high - down in front of my partner and I. ... August 9th, 2019 The OIG Work Plan: What Is It and Why Should I Care?| Published August 9th, 2019 - Last Review/Update August 14th, 2019 The Department of Health and Human Services (HHS) founded its Office of Inspector General (OIG) in 1976 and tasked it with the responsibility to combat waste, fraud, and abuse within Medicare, Medicaid, and the other HHS programs. With approximately 1,600 employees, HHS OIG is the largest inspector general's office within ... July 19th, 2019 The Facts of Critical Care| Published July 19th, 2019 - Last Review/Update July 30th, 2019 Critical care services remain to not only be an area of confusion for providers, coders, and auditors, but also a constant target for the carriers for audit. We can sit back and look at critical care and think of all of the ways the code descriptor and/or use could be ... July 12th, 2019 5 Ways to Minimize HIPAA Liabilities| Published July 12th, 2019 - Last Review/Update July 30th, 2019 Last year was historic for HIPAA enforcement. The HHS Office of Civil Rights collected a record $23.5 million in settlements and judgments against providers guilty of HIPAA violations. To avoid becoming part of that unwanted statistic, it’s important to pay extra close attention to five key areas of HIPAA vulnerability.
Take ... June 18th, 2019 How to Properly Report Monitoring Patients Taking Blood-thinning Medications| Published June 18th, 2019 - Last Review/Update June 19th, 2019 Codes 93792 and 93792, which were added effective January 1, 2019, have specific guidelines that need to be followed. This article provides some guidance and tips on properly reporting these services. January 22nd, 2019 Home Oxygen TherapyThere are more articles. View all articles... View articles for the current specialty by subtopic: Select the webinar title to view a summary and link to the webinar video. January 23rd, 2018 How to PREVENT and HEAL Dental Problems so You Can Enjoy a Healthy Body and LifeIn this webinar Dr. Jorgensen will share with you the REAL causes of dental disease and techniques for prevention and healing. You will also learn about dental problems that may be making you or your patients SICK, how to identify them, and what can be done to help them get better. Finally, she will tell you about cutting edge dental and health practices you need to know about to improve your patient's health, and how to find a dentist that can provide this care. Don't miss this life-changing webinar! January 4th, 2018 Proper Coding and Billing for Drugs, Biologicals and InjectionsProper Coding and Billing for Drugs, Biologicals and Injections February 2nd, 2017 How to Check NCCI Edits Using FindACodeHow to Check NCCI Edits Using FindACode 2020 Pain Management ICD-10-CM Coding Book2020 Pain Management Reimbursement GuideAdvanced Beneficiary Notice of Noncoverage (ABN) Form Instructions ToolBilateral Surgeries: Claim SubmissionCenters for Medicare & Medicaid Services Patient-Driven Groupings ModelCMS Proposes Elimination of RAPs, $250 Million Medicare Payment IncreaseCommonly Used Medicare Modifiers - GA, GX, GY, GZCompliance Program Guidance for Home Health AgenciesCompliance Program Guidance for HospicesDME Billing guideanceHome Health Agency Billing - Ch 10 Medicare claims processing manualHome Health Billing FAQsHospice Medicare Billing Codes SheetMedicare Part B Clinical Laboratory Fee ScheduleNoridian: Allowed Amount ReductionsPhysician Assistant (PA) Resources NoridianPUB-100 CMS-Billing Instructions Regarding Payment for Hospice Care Based on Location Where Care is FurnishedSNF Inpatient Part A Billing and SNF Consolidated Billing - Medicare Claims processing ManualSummary of the HIPAA Privacy Rule by HHSWhat Is PDGM and What Will it Mean for Your HHA? Select the podcast title to view a summary and link to the podcast. August 25th, 2020 Do You Have All the Right Dental Resources Needed to Succeed in Dental Medical Billing and Coding?Discussion with LaMont Leavitt (CEO of innoviHealth) and Christine Taxin (Adjunct professor at New York University, President of Dental Medical Billing, and Links2Success).
Some of the resources and tools they discuss will help you with your dental coding/billing and education.
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