- Avoiding Reason Code 38200
- Correcting Reason Code 37253
- Reason Code 39929
- Influenza and Pneumonia Vaccinations in the Home Health and/or Hospice Setting
- Certification or Recertification of Medicare Covered Home Health Services
- Billing the Home Health Period of Care Claim - PDGM
- Disposable Negative Pressure Wound Therapy Services Under Home Health
- MLN Matters® 11855 Request for Anticipated Payment Submission Frequently Asked Questions
- Home Health Prospective Payment System Booklet
- Home Health Third Party Liability Demand Billing
- Home Health Demand Billing
- Counting 60-Day Episodes
- Notice of Admission Questions and Answers
- Home Health Patient-Driven Groupings Model (PDGM) FAQs
- Billing the Home Health Notice of Admission Electronically
- Billing the Home Health Notice of Admission via DDE
- Home Health Requests for Anticipated Payment
- Home Health Transfers
- Home Health Agency Transfer and Dispute Protocol
- Late Notice of Admission - The Exception Process
- Reporting Home Health Episodes with No Skilled Visits
- Telehealth Home Health Services: New G-Codes
- Reporting Site of Service Codes for Home Health Care
- PDGM Resources
- Billing G-Codes for Therapy and Skilled Nursing Services
- Correcting and Avoiding Reason Code 38157: Duplicate Request for Anticipated Payment
- Correcting and Avoiding Reason Code C7080: Inpatient Overlap
- Completing the Advance Beneficiary Notice for Home Health Agency Demand Claims
- Correcting and Avoiding Reason Code C7010: Overlap With a Hospice Election Period
- The Medicare Home Infusion Therapy Benefit and Home Health Agencies
- Home Health Therapy Billing
- Home Health Billing When a New MBI is Assigned
- Correcting and Avoiding Overlap Reason Codes
- 30-Day Home Health Therapy Reassessment Schedule
Reporting Home Health Episodes with No Skilled Visits
Eligibility for the Medicare HH benefit requires that the beneficiary have a need for intermittent skilled nursing care, PT, SLP, or a continuing need for OT. The need for skilled care makes the patient eligible for other covered HH services (dependent services), i.e., HH aide visits, medical social services, medical supplies, and DME. These services must be billed along with skilled services on the HH claim.
Impact to HHAs
CMS recognizes that there may be circumstances in which a HHA is not able to deliver the skilled services planned for the episodes, e.g., an unexpected inpatient admission. CMS IOM Publication 100-02, Medicare Benefit Policy Manual, Chapter 7, Section 40.1.3 states:
Since the need for "intermittent" skilled nursing care makes the patient eligible for other covered home health services, the Medicare contractor should evaluate each claim involving skilled nursing services furnished less frequently than once every 60 days. In such cases, payment should be made only if documentation justifies a recurring need for reasonable, necessary, and medically predictable skilled nursing services.
Condition code 54 indicates the HHA provided no skilled services during the billing period, but the HHA has documentation on file of an allowable circumstance. HHAs should include condition code 54 on HH final episode claims received on or after 7/1/2016 which are billed with no skilled services in conjunction with qualifying dependent services. Claims without skilled visits that are submitted without the new condition code will be RTP for correction.