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J15 HH&H FAQs

WEBThis product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software …

Actived: 9 days ago

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

Physician NPP Guide to Home Health

WEBJune 14, 2021. Physician NPP Guide to Home Health. A patient must meet the following five criteria to meet eligibility for home health services: Homebound Status: No …

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Care Plan Oversight and Certification/Recertification Services for

WEBNote: Refer to a HCPCS manual for additional information. The types of services that are included are noted in the narrative descriptions for each HCPCS code. Claim Submission. Submit HCPCS code G0180 when the patient has not received Medicare covered home health services for at least 60 days.

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Medically Necessary and Reasonable

WEBMedically Necessary and Reasonable. Medicare Benefit Policy Manual (CMS Pub. 100-02, Ch. 7 §20.1) All services billed to Medicare must meet the criteria of …

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Home Health Billing Codes

WEBHome Health Billing Codes. The following codes represents that most frequently submitted on home health RAPs/claims. A complete listing of all codes is accessible from the National Uniform Billing Committee (NUBC) Official UB-04 Data Specifications Manual.. The Medicare Claims Processing Manual (CMS Pub. 100-04, Ch. 10) describes bill …

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National and Local Coverage Determinations (NCDs and LCDs)

WEBNational and Local Coverage Determinations (NCDs and LCDs) An NCD sets forth the extent to which Medicare will cover specific services, procedures, or …

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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 …

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New Home Health Documentation Checklist Tool

WEBNew Home Health Documentation Checklist Tool. CGS has developed a new tool for home health clinical staff to use as a checklist of all the coverage criteria for 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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Self-Service Options

WEBSelf-Service Options. The following tools are designed for home health and hospice providers who submit claims to CGS. Disclaimer: CGS' online tools and calculators are …

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Defining Home Health Visits

WEBDefining Home Health Visits. Medicare Benefit Policy Manual (CMS Pub. 100-02, Ch. 7, § 70.2A) A visit is an episode of personal contact with the beneficiary by staff of the home health agency, or by others under contract or under arrangement with the home health agency, for the purpose of providing a covered home health service.

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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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CMS Home Health Condition of Participation Frequently Asked …

WEBThe Home Health Agency Conditions of Participation Interpretive Guidelines Frequently Asked Questions will be posted to the CMS Home Health Providers Web …

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Determining Homebound

WEBThe Centers for Medicare and Medicaid Services (CMS) released a clearer definition of homebound to be used when deciding if patients are eligible for home …

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Home Health Ordering/Referring Requirements

WEBProviders enter the ordering/referring physician’s NPI and name on FISS Claim Page 03 as shown below. FISS Claim Page 03. Taking the following step will help …

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Home Health Face-to-Face (FTF) Encounter

WEBThe initial (Start of Care) certification must include documentation that an allowed physician or non-physician practitioner (NPP) had a face-to-face (FTF) encounter with the patient. The FTF encounter must be related to the primary reason for the home care admission. This requirement is a condition of payment.

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Submitting a Final Claim under the Home Health Patient-Driven Groupings

WEBEffective for home health periods of care beginning January 1, 2020, Change Request (CR) 11081 implements the policies of the home health Patient-Driven Groupings Model (PDGM) as described in the Calendar Year (CY) 2019 home health (HH) final rule ( CMS-1689-FC ). The PDGM changed the unit of payment from 60-day …

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