Discharge and Readmission Situation Under HH PPS -

10.1.14 - Discharge and Readmission Situation Under HH PPS - Payment Effects (Rev. 10758; Issued: 05-11-21; Effective: 01-01-22; Implementation: 08-11-21) Under HH PPS, HHAs may discharge beneficiaries before the period of care has closed if all treatment goals of the plan of care have been met. Cases may occur in which an HHA has discharged a beneficiary during a period of care, but the beneficiary is readmitted to the same agency in the same 30 days. Since no portion of the period can be paid twice, the first payment must be pro-rated to reflect the shortened period (see §10.1.15). A new admission period can be opened by the HHA. Medicare systems will allow this in cases where the CMS certification number (CCN) on the new NOA matches the CCN on the prior period. The next period of care will begin the date the first service is supplied under readmission (setting a new 30-day “clock”). Note that beneficiaries do not have to be discharged within the period because of admissions to other types of health care providers (i.e., hospitals, skilled nursing facilities), but HHAs may choose to discharge in such cases. If an agency chooses not to discharge and the patient returns to the agency in the same 30-day period, the same period of care continues. However, if an agency chooses to discharge, based on an expectation that the beneficiary will not return, the agency should recognize that if the beneficiary does return to them in the same period, the discharge is not recognized for Medicare payment purposes. All the HH services provided in the complete period of care, both before and after the inpatient stay, should be billed on one claim. When discharging, full payment would still be made unless the beneficiary received more home care later in the same period. Discharge is not required if the beneficiary has an inpatient stay that spans the end of the first 30-day period of care in a 60-day certification period. The HHA should submit the claim for the period following the discharge as if the 30-day periods were contiguous – submit a From date of day 31, even though it falls during the inpatient stay and the first visit date that occurs after the hospital discharge. Medicare systems will allow the HH claim to overlap the inpatient claim for dates in which there are no HH visits.