Partial Payment Adjustment

10.7 - Partial Payment Adjustment (Rev. 10438, Issued: 11-06-20, Effective: 03-01-20, Implementation: 01- 11-21) A. Partial Payment Adjustment Criteria An HHA receives a national, standardized 30-day payment of a predetermined rate for home health services unless CMS determines an intervening event warrants a new 30- day period for purposes of payment. The partial payment adjustment is a proportion of the period payment and is based on the span of days including the start-of-care date (for example, the date of the first billable service) through and including the last billable service date under the original plan of care before the intervening event, defined as a— ● Beneficiary elected transfer, or ● Discharge and return to home health that would warrant, for purposes of payment, a new OASIS assessment, certification of eligibility, and a new plan of care. When a new 30-day period begins due to an intervening event, the original 30-day period will be proportionally adjusted to reflect the length of time the beneficiary remained under the agency’s care prior to the intervening event. The proportional payment is the partial payment adjustment. B. Methodology Used to Calculate Partial Payment Adjustment The partial payment adjustment for the original 30-day period is calculated to reflect the length of time the beneficiary remained under the care of the original HHA based on the first billable visit date through and including the last billable visit date. The partial payment adjustment will be calculated by using the span of days (first billable service date through and including the last billable service date) under the original plan of care as a proportion of the 30-day period. The proportion will then be multiplied by the original case-mix and wage index to produce the 30-day payment. C. Common Ownership Exception to Partial Payment Adjustment The partial payment adjustment does not apply in situations of transfers among HHAs of common ownership. Those situations would be considered services provided under arrangement on behalf of the originating HHA by the receiving HHA with the ownership interest until the end of the 30-day period. The common ownership exception to the transfer partial payment adjustment does not apply if the beneficiary moved out of their Metropolitan Statistical Area (MSA) or non-MSA during the 30-day period before the transfer to the receiving HHA. D. Beneficiary Elected Transfer Verification In order for a receiving HHA to accept a beneficiary elected transfer, the receiving HHA must document that the beneficiary has been informed that the initial HHA will no longer receive Medicare payment on behalf of the patient and will no longer provide Medicare covered services to the patient after the date of the patient's elected transfer in accordance with current patient rights requirements at 42 CFR 484.50(d). The receiving HHA must also document in the record that it accessed the Medicare contractor’s inquiry system to determine whether or not the patient was under an established home health plan of care and it must contact the initial HHA on the effective date of transfer. In the rare circumstance of a dispute between HHAs, the Medicare contractor is responsible for working with both HHAs to resolve the dispute. If the receiving HHA can provide documentation of its notice of patient rights on Medicare payment liability provided to the patient upon transfer and its contact of the initial HHA of the transfer date, then the initial HHA will be ineligible for payment for the period of overlap in addition to the appropriate partial payment adjustment. If the receiving HHA cannot provide the appropriate documentation, the receiving HHA's RAP and/or final claim will be cancelled, and full period payment will be provided to the initial HHA. For the receiving HHA to properly document that it contacted the initial HHA on the effective date of transfer it must maintain similar information as the initial HHA, including the same basic beneficiary information, personnel contacted, dates and times. The initial HHA must also properly document that it was contacted and it accepted the transfer. Where it disputes a transfer, the initial HHA must call its Medicare contractor to resolve the dispute. The Medicare contractor is responsible for working with both HHAs to resolve the dispute.