100-04 Medicare Claims Processing Manual: Chapter 10 Crosswalk

Medicare Claims Processing Manual
Home Health Agency Billing
Crosswalk
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10 	10 	A3-3638.20 	HH-401-402,
HH-429
General Guidelines for Payment of HHA
Claims
10 	10.1 	A3-3639 	HH-467 	Home Health Prospective Payment System (HH
PPS)
10 	10.1.1 	A3-3639.1 	HH-467.1 	Creation of HH PPS
10 	10.1.2 	A3-3639.3 	HH-467.3, 	Commonalities of the Cost Payment and HH
PPS Environments
10 	10.1.3 	A3-3639.5,
A3-3639.6
HH-467.5,
HH-467.6,
Configuration of the HH PPS Environment
10 	10.1.4 	A3-3639.7 	HH-467.7, 	The HH PPS Episode - Unit of Payment
10 	10.1.5 	A3-3639.8 	HH-467.8, 	Number, Duration, and Claims Submission of
HH PPS Episodes
10 	10.1.5.1 	A3-3638.16,
A3-3638.5
HH-439, 440 	More Than One Agency Furnished Home
Health Services
10 	10.1.5.2 	A3-3639.9 	HH-467.9, 	Effect of Election of HMO and Eligibility
Changes on HH PPS Episodes

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10 	10.1.6 	A3-3639.10 	HH-467.10, 	Split Percentage Payment of Episodes and
Development of Episode Rates
10 	10.1.7 	A3-3639.11 	HH-467.11, 	Basis of Medicare Prospective Payment
Systems and Case-Mix
10 	10.1.8 	A3-3639.12 	HH-467.12, 	Coding of HH PPS Episode Case-Mix Groups
on HH PPS Claims: (H)HRGs and HIPPS
Codes
10 	10.1.9 	A3-3639.13,
A3-3639.14
HH-467.13,
HH-467.14
Composition of HIPPS Codes for HH PPS
10 	10.1.10 	A3-3639.15 	HH-467.15, 	Provider Billing Process Under HH PPS
10 	10.1.10.1 	A3-3639.16 	HH-467.16, 	Grouper Links Assessment and Payment
10 	10.1.10.2 	A3-3639.17 	HH-467.17, 	Health Insurance Query for Home Health
Agencies (HIQH) Inquiry System Shows
Primary HHA
10 	10.1.10.3 	A3-3639.18 	HH-467.18, 	Submission of Request for Anticipated Payment
(RAP)
10 	10.1.10.4 	A3-3639.19 	HH-467.19, 	Claim Submission and Processing
10 	10.1.11 	A3-3639.20 	HH-467.20, 	Payment, Claim Adjustments and Cancellations
10 	10.1.12 	A3-3639.21 	HH-467.21, 	Request for Anticipated Payment (RAP)
10 	10.1.13 	A3-3639.22 	HH-201.8E,
HH 467 22
Transfer Situation - Payment Effects

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HH-467.22,
10 	10.1.14 	A3-3639.23 	HH-467.23, 	Discharge and Readmission Situation Under
HH PPS - Payment Effects
10 	10.1.15 	A3-3639.28 	HH-467.28, 	Adjustments of Episode Payment - Partial
Episode Payment (PEP)
10 	10.1.16 	A3-3639.24 	HH-467.24, 	Payment When Death Occurs During an HH
PPS Episode
10 	10.1.17 	A3-3639.25 	HH-467.25, 	Adjustments of Episode Payment - Low
Utilization Payment Adjustments (LUPAs)
10 	10.1.18 	A3-3639.26 	HH-467.26, 	Adjustments of Episode Payment - Special
Submission Case: "No-RAP" LUPAs
10 	10.1.19 	A3-3639.27 	HH-467.27, 	Adjustments of Episode Payment - Therapy
Threshold
10 	10.1.20 	A3-3639.29 	HH-467.29, 	Adjustments of Episode Payment - Significant
Change in Condition (SCIC)
10 	10.1.21 	A3-3639.30 	HH-467.30, 	Adjustments of Episode Payment - Outlier
Payments
10 	10.1.22 	A3-3639.31 	HH-467.31, 	Adjustments of Episode Payment - Exclusivity
and Multiplicity of Adjustments
10 	10.1.23 	A3-3639.33 	HH-467.33, 	Exhibit: General Guidance on Line Item Billing
Under HH PPS

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10 	10.1.24 	A3-3639.34 	HH-467.34, 	Exhibit: Acronym List
10 	10.1.25 	A3-3639.35, 	HH-467.35, 	PM-AB-00-112 	HH PPS Consolidated Billing and Primary
HHAs
10 	20 	PM-AB-01-111,
PM AB-01-65,
Dated 4/26/01
Completion of Home Health Prospective
Payment System (HH PPS) Consolidated
Billing Enforcement
10 	20.1 	Exception of Supplies from Consolidated
Billing Edits on Institutional Claims
10 	20.2 	PM-AB-01-70,
Dated 5/1/01
Only RAP Received and Services Fall Within
60 Days after RAP Start Date
10 	30 	A3-3640 	HH-468, 	Common Working File (CWF) Requirements
for the Home Health Prospective Payment
System (HH PPS)
10 	30.1 	A3-3640.1 	HH-468.1, 	Health Insurance Query for Home Health
Agencies (HIQH)
10 	30.2 	A3-3640.2 	HH468.2, 	HIQH Inquiry and Response
10 	30.3 	A3-3640.3 	HH-468.3, 	Timeliness and Limitations of HIQH Responses
10 	30.4 	A3-3640.4 	HH-468.4, 	Inquiries to RHHIs Based on HIQH Responses
10 	30.5 	A3-3640.5 	HH-468.5, 	National Home Health Prospective Payment
Episode History File

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10 	30.6 	A3-3640.6 	HH-468.6, 	Opening and Length of HH PPS Episodes
10 	30.7 	A3-3640.7 	HH-468.7 	Closing, Adjusting and Prioritizing HH PPS
Episodes Based on RAPs and HHA Claim
Activity
10 	30.8 	A3-3640.8 	HH-468.8, 	Other Editing and Changes for HH PPS
Episodes
10 	30.9 	A3-3640.9 	HH-468.9, 	Priority Among Other Claim Types and HH
PPS Consolidating Billing for Episodes
10 	30.10 	A3-3640.10 	HH-468.10, 	Medicare Secondary Payment (MSP) and the
HH PPS Episodes File
10 	30.11 	A3-3640.11 	HH-468.11, 	Exhibit: Chart Summarizing the Effects of
RAP/Claim Actions on the HH PPS Episode
File
10 	40 	A3-3638.22,
A3-3638.13
HH-475, 	Completion of Form CMS-1450 for Home
Health Agency Billing
10 	40.1 	A3-3638.23 	HH-475.1, 	Request for Anticipated Payment (RAP)
10 	40.2 	A3-3638.24 	HH-475.2, 	HH PPS Claims
10 	40.3 	A3-3638.25 	HH-475.3, 	HH PPS Claims When No RAP is Submitted -
"No-RAP" LUPAs

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10 	40.4 	A3-3638.10 	HH-400,
HH-463
Def. of nom. Chg. from
42 CFR 410.2
Collection of Deductible and Coinsurance from
Patient
10 	40.5 	A3-3638.14 	Billing for Nonvisit Charges
10 	50 	A3-3638.30, 	PM-A-01-05 	Beneficiary-Driven Demand Billing Under HH
PPS
10 	70 	HH-475.4 	HH PPS Pricer Program
10 	70.1 	HH-475.4.A 	General
10 	70.2 	HH-475.4.B 	Input/Output Record Layout
10 	70.3 	HH-475.4.C 	Decision Logic Used by the Pricer on RAPs
10 	70.4 	HH-475.4.D 	Decision Logic Used by the Pricer on Claims
10 	70.5 	HH-475.4.E 	Annual Updates to the HH Pricer
10 	80 	HHA 475.5 	Special Billing Situations Involving OASIS
Assessments
10 	90 	A3-3638.9,
A3-3638.19
HH-461, 	Medical and Other Health Services Not Covered
Under the Plan of Care (Bill Type 34X)
10 	90.1 	A3-3638.21 	Osteoporosis Injections as HHA Benefit
10 	90.2 	Billing Instructions for Pneumococcal
Pneumonia, Influenza Virus, and Hepatitis B
Vaccines

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10 	100 	A3-3638.17 	Temporary Suspension of Home Health
Services
10 	110 	HH-432 	Billing Procedures for an Agency Being
Assigned Multiple Provider Numbers or a
Change in Provider Number