CMS Requires HIPPS Codes on Medicare Advantage Plan Claims
Tuesday, June 25, 2013
by: VNAA Policy Team

Section: Public Policy and Advocacy

Effective July 1, 2013 home health agencies will be required to include a Health Insurance Prospective Payment System (HIPPS) code on Medicare Advantage (MA) claims, however the edits for this new requirement will not be turned on until September. An exact date and additional details are still forthcoming from the Centers for Medicare and Medicaid Services (CMS). At this time, there is no payment consequence for MA plans that do not submit a HIPPS code for home health services; home health claims should not be delayed either. CMS expects the HIPPS code to be entered on claims the same way it is for fee for service Medicare.
CMS instructed MA organizations to reject any home health claim that does not include a HIPPS code. CMS is requiring the HIPPS codes on home health claims to accurately price home health.
CMS has not provided any direct communication with the home health providers. Many agencies were informed of this new requirement through their contracted MA plans. However, most agencies have not received any notifications.
There are two major concerns related to provider compliance: 1) some agencies are reimbursed on a per visit basis by MA plans and 2) agencies will need time to change their software systems to accommodate and, it is unclear how long such a change would take.
Providers should be begin working with their vendors to make the necessary changes to software systems to prepare for the compliance date announcement. Providers should also contact health plans to determine what specifically is required related to including the HIPPS code on claims.
CMS is meeting with MA plans this week to clarify this policy and direct them to advise home health providers accordingly. VNAA will be working with CMS regarding the issue and will update members when further information becomes available.
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