Claim Submission and Processing

10.1.10.4 - Claim Submission and Processing (Rev. 10758; Issued: 05-11-21; Effective: 01-01-22; Implementation: 08-11-21) Payment due to an HHA for a period of care will be made based on a claim submitted at the end of the 30-day period, or after the patient is discharged, whichever is earlier. HHAs may not submit this claim until after all services are provided for the period and the physician has signed the plan of care and any subsequent verbal order. All HH PPS claims must be submitted with TOB 0329. The HH PPS claim will include line item detail describing all the services provided in the period of care. At a provider’s option, any durable medical equipment, oxygen or prosthetics, and orthotics provided may also be billed on the HH PPS claim, and this equipment will be paid in addition to the period of care payment. However, osteoporosis drugs and disposable negative pressure wound therapy (dNWPT) services must be billed separately on TOB 034x claims, even when an admission period is open. See section 90. Claims for periods of care may span calendar and fiscal years. Payment rates are determined for all services on the claim using the Statement Covers Period “Through” date on the claim. Once the payment for a period of care is calculated, Medicare claims processing systems determine whether the claim should be paid from the Medicare Part A or Part B trust fund. This A-B shift determination does not affect HHA payment amounts. Informational value codes for A and B visits (value codes 62 and 63) and dollar amounts (64 and 65) may be visible to HHAs on electronic claim remittance records, but providers do not submit these value codes.