Transfer Situation - Payment Effects

10.1.13 - Transfer Situation - Payment Effects (Rev. 10758; Issued: 05-11-21; Effective: 01-01-22; Implementation: 08-11-21) By law under the HH PPS system, beneficiaries must be able to transfer among HHAs, and payments must be pro-rated to reflect these changes. To accommodate this requirement, HHAs submit an NOA with condition code 47 to indicate a transfer when an admission period may already be open for the same beneficiary at another HHA. 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 484.10(e). Documentation of these notifications may be needed if the transfer is disputed and verification is required as described in the Medicare Benefit Policy Manual, chapter 7, section 10.8.E. The receiving HHA must also document in its records that it accessed a Medicare inquiry system to determine whether or not the patient was under an established home health plan of care and contacted the initial HHA on the effective date of transfer. In such cases, the previously open admission period will be automatically closed in Medicare claims processing systems as of the date services began at the HHA the beneficiary transferred to, as reported in the NOA. The new admission period for the “transfer to” agency will begin on that same date. Payment will be pro-rated for the last claim in the closed admission period of the “transferred from” agency.