More Than One Agency Furnished Home Health Services

10.1.5.1 - More Than One Agency Furnished Home Health Services (Rev. 10758; Issued: 05-11-21; Effective: 01-01-22; Implementation: 08-11-21) The primary HHA bills for all services furnished by both agencies and keeps all records pertaining to the care and other HHAs serving the same beneficiary. Nonprimary HHAs can receive payment under arrangement only from the primary HHA for services on the plan of care where prior arrangement exists. The primary agency’s status as primary is established through the submission, receipt and processing of a Notice of Admission (NOA) for the home health care for the beneficiary. The secondary agency is paid through the primary agency under mutually agreed upon arrangements between the two agencies existing before the delivery of services for services called for under the plan of care. Two agencies must never bill as primary for the same beneficiary for the same admission period. When the Common Working File (CWF) indicates an admission period is open for a beneficiary, the A/B MAC (HHH) returns to the provider the NOA of any other agency billing unless the NOA indicates a transfer or discharge and readmission situation exists. In rare cases, a Medicare beneficiary may receive an organ transplant and the organ donor’s post-operative services are covered by the Medicare program. Since the donor is frequently not a Medicare beneficiary, services for the donor are billed using the Medicare beneficiary’s Medicare number. If both the organ recipient and organ donor are receiving post-operative home health services, CWF cannot process HH PPS periods for both patients for the same dates of service. In this case, the HH claim for the organ recipient is accepted by CWF. The HH claim for the donor is processed by the A/B MAC (HHH) outside CWF.