The home health agency has to finalize their billing and code the final bill such that the CWF is triggered to indicate that home health is no longer in charge of the patient care. The edits work to prevent a home helath agency from seeing people and an outpatient clinic seeing the same person at the same time since therapy would be ncluded in the fee to the HHA. Unfortunately there is not a lot you can do until the HHA finishes their billing. We have contacted some and asked them where they are in the process and if they have coded it correctly to indicate the end of the HHA involvement with the patient. Hold onto the patient claims because you can get paid once the HHA gets their part done. Keep in mind that the CWF is usually behind on getting the most recent information posted.
-----Original Message----- From: Chriss, Theresa M. [mailto:[EMAIL PROTECTED] Sent: Tuesday, April 06, 2004 8:21 AM To: AANAC Q&A (E-mail) Subject: question regarding billing for outpatient I don't know much about this, but here it goes! We were told that before our facility can bill for outpatient services, the patient needs to be officially "closed out" by their home health agency. Apparently what was happening was that Medicare considered the patient to be open for 60 days with home health. When in fact, they were in home health 2 weeks, and then to our facility for outpatient therapies. I guess when we went to bill, we were denied, because they were still in home health. Does anyone know anything about this and what procedures to follow to ensure proper payment?? Right now, we've had 2 denied. So we are no longer accepting patients for outpatient if they've been in home health. THANKS TERRI :0) /---------------------------------------------------------- The Case Mix Discussion Group is a free service of the American Association of Nurse Assessment Coordinators "Committed to the Assessment Professional" Be sure to visit the AANAC website. Accurate answers to your questions posted to NAC News and FAQs. For more info visit us at http://www.aanac.org -----------------------------------------------------------/ /---------------------------------------------------------- The Case Mix Discussion Group is a free service of the American Association of Nurse Assessment Coordinators "Committed to the Assessment Professional" Be sure to visit the AANAC website. Accurate answers to your questions posted to NAC News and FAQs. For more info visit us at http://www.aanac.org -----------------------------------------------------------/
