HIPPS Code Edits on Medicare Advantage Claims Start December 1, 2013
Tuesday, July 9, 2013
by: VNAA Policy Team

Section: Public Policy and Advocacy




The Centers for Medicare and Medicaid Services (CMS) confirmed that the new requirement for Medicare Advantage (MA) plans to report Health Insurance Prospective Payment System (HIPPS) codes on all home health claims will impact payment starting December 1, 2013.

While the new HIPPS requirement goes into place on July 1, 2013, CMS will do only “informational edits” until December 1 when missing data will impact payment. Providers should contact their MA plans immediately and work with their vendors to make the necessary changes to software systems.

On a June 25, conference call with CMS, VNAA discussed several concerns:

  1. HIPPS codes are designed for an episode of care and this requirement is designed for a visit encounter so this will be a difficult transition.
  2. Home health agencies need time to change their software systems to accommodate and, it is unclear how long such a change would take; 
  3. Stronger communications need to be in place between CMS, MA plans and home health agencies; and
  4. A July 1 reporting requirement seems unreasonable given the lack of communication and support for making this change.
CMS is not providing any direct communication with the home health providers and instead is relying on MA plans to inform providers the new requirement.
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