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Recent testing of home health consolidated billing has revealed that Medicare regional home health intermediaries have a problem with common working file edits. If a home health episode of care is denied, the therapy services for that episode can be resubmitted by the same home health agency on a different type of bill and the claim can be paid.

That is, the edits are not rejecting a claim for home health services not under a plan of care (type of bill 34x) if it falls within a denied home health episode with the same provider number.

With an effective date of October 1, 2000, Medicare systems will reject a claim for home health services not under a home health plan or care that contains services subject to consolidated billing when a denied home health episode is present and the provider number on the incoming home health claim and on the home health episode match. When the date of earliest billing activity and the date of latest billing activity on a home health episode are blank, Medicare systems will reject a 34x claim that contains services subject to consolidated billing when the provider number matches the home health episode, and the service dates fall within the home health episode start and end dates.

# posted by Medical Information : 3:13 AM