Three issues are discussed below. If you use HAVEN, be aware there was a
"bug" and you need to update with the GROUPER DLL Version 1.03 file
immediately. We will place transmittal 296 on our Website by this Wednesday
if our members want to wait a few days for easier access.
Gene Tischer
gtischer@ahhif.org
Assoc. Home Hlth Industries of FL
http://www.ahhif.org
----- Original Message -----
From: "State Association Forum" <forum@list2.nahc.org>
Sent: Monday, August 28, 2000 12:46 PM
Subject: Broadcast:PPS Update
FROM: Mary St. Pierre, NAHC, Regulatory Affairs
NAHC received two documents important for the implementation of home
health PPS.
CORRECTIONS TO GROUPER DLL AND RELATED RULES
The first file includes details about problems with and corrections to the
HCFA Grouper Software. NAHC was notified in a telephone call from Bob
Wardwell on Friday that Abt Associates found problems with the grouper
software. These problems are being corrected. They include
1. Diagnosis code problems due to failure of the program to recognize the
4th and 5th digit diagnoses for those diagnoses appearing as 3 digits in
the Federal Register.
2. Changes to the software program skip logic that will require that the
value for M0445 be consistent with the entered value for M0450
3. Addition of programming that will require data to pass relevant
inter-item checks as a condition of earning case mix points.
What to do?
Agencies should install the new GROUPER DLL Version 1.03 immediately.
Agencies using HAVEN 4.0 can download the file from the HCFA web-site and
copy it to their PC. Agencies using vendors will need to contact their
vendor about these changes. The full instruction is included in the
attached file.
MEDICARE HOME HEALTH AGENCY MANUAL TRANSMITTAL 296
The second document is a zipped file containing the update to the HIM-11
detailing billing procedures for PPS. You must have unzip software in
order
to open and print this file. It is over 90 pages in length.
PPS ISSUE CLARIFICATION FROM HCFA
The following information was provided verbally by HCFA in response to
requests for clarification. NAHC is awaiting written responses to a series
of questions submitted to HCFA several weeks ago and will post these
responses as soon as received.
1. If an agency fails to submit an episode claim within the 60 day time
limit, the RAP payment will be recouped from the agency and the RAP will
be
> cancelled. In order to receive payment for the episode, the agency must
> resubmit the RAP, followed by the claim. Agencies are urged to allow at
> least 24 hours between submission of the RAP and the claim in order to
> allow the RAP to process first.
> 2. The PPS system will provide two methods to make billing corrections. If
> an agency makes an error on a RAP, the original RAP must be cancelled and
a
> new RAP submitted. If an agency makes an error on a claim that results in
> wrong payment (e.g. wrong HIPPS code), the agency should cancel the claim
> (which will automatically cancel the RAP), submit a correct RAP, followed
> by a correct claim. If an agency makes an error within a claim (e.g. ,
> omitted a nursing visit date) an adjusted claim may be submitted to
correct
> the error or omission.
> 3. The primary agency is determined for each episode based on receipt of a
> RAP for that episode. A new RAP is needed for every subsequent episode in
> order to establish your agency as primary, even if care is continuous.
> 4. The default logic built into the PPS claims processing system will, unnfortunately, allow a second agency to bill and receive payment even if a
> primary agency has a RAP on file for overlapping dates of service. The
> primary agency will be denied payment for overlapping dates of service.
>
> NAHC staff will attend a meeting at HCFA later today, along with other
> industry representatives, to discuss the implementation of PPS. Detailed
> information about this meeting will be provided tomorrow.
>
>
>
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