CMS Corrects Home Health Pricer Error

The Centers for Medicare & Medicaid Services (CMS) has issued Change Request 9608 that revises the Home Health (HH) Pricer to correct errors identified in the program that caused incorrect payments to home health agencies (HHAs). The system changes will correct an error that caused incorrect payments on claims where 20 or more therapy visits were provided.
The HH Pricer program routinely validates whether the HIPPS code on a claim is supported by the appropriate number of therapy services. If the number of therapy services is higher or lower than what is reflected in the HIPPS code, the Pricer re-codes the claim and a HIPPS code corresponding to the actual therapy services is paid. Since the January 2016 update to the HH Pricer, the program performed this action incorrectly when the provider-submitted HIPPS codes begins with 5, indicating 20 or more therapy visits are provided.
The revised HH Pricer will be implemented on April 25, 2016. After this implementation is completed, MACs will adjust the affected HH claims.