Exhibit: Chart Summarizing the Effects of NOA/Claim Actions

30.11 - Exhibit: Chart Summarizing the Effects of NOA/Claim Actions on the HH PPS Episode File (Rev. 10758; Issued: 05-11-21; Effective: 01-01-22; Implementation: 08-11-21) The following chart summarizes basic effects of HH PPS claims processing on the episode record. Even though under the PDGM, the HH unit of payment is a 30-day period of care, this file continues to be named ‘the episode file’ in CWF and references to ‘episode record’ below refer to periods of care. Transaction How CWF Is Impacted How Other Providers Are Impacted NOA • Opens an episode record using NOA “From” date to set Period Start Date • CWF uses Start Date to calculate admission period • Period End Date is automatically calculated to extend through 30th day • DOEBA and DOLBA are left blank • NOA indicator is set to 1 • Other NOAs submitted during this open admission period will be rejected unless an indicator of a transfer or discharge/readmission is present NOA with condition code 47 • Opens an episode record using NOA’s “From” date to set Period Start Date • Period End Date is automatically calculated to extend through 30th day • DOEBA and DOLBA are left blank • The Period End Date (if later than the NOA “From” date) is automatically changed to reflect the NOA’s “from” date. • NOA indicator is set to 2 • CWF uses the new Start Date as the end date of the previous admission period. • The Period End Date created by the NOA or claim of the HHA the beneficiary is transferring from is automatically changed to reflect the "from" date on the NOA submitted by the HHA the beneficiary is transferring to. The HHA the beneficiary is transferring from cannot bill for services past the date of transfer. • Another HHA cannot bill during this episode unless another transfer NOA is submitted. Transaction How CWF Is Impacted How Other Providers Are Impacted NOA Cancellation by Provider (TOB 032D) • The episode record is deleted from CWF • No episode record is present to prevent NOA submission by another provider, making that provider the primary HHA for the dates of the episode Claim (full 30-day period, patient status 30) • 30-day record is completed • Period End Date remains at the 30th day • DOEBA is updated to reflect first visit date in period • DOLBA is updated to reflect last visit date in episode • CWF considers the admission period still open. • Other NOAs submitted during this open period will be rejected unless an indicator of a transfer or discharge/readmission is present Claim (discharge with goals met prior to Day 30) • 30-day record is completed • Period End Date remains at the 30th day; • DOEBA is updated to reflect first visit date in episode • DOLBA is updated to reflect last visit date in episode • CWF uses the Period End Date as the end date of the admission period also. • Other NOAs submitted with “From” dates before the end date of this period will be rejected unless an indicator of a transfer or discharge/readmission is present Transaction How CWF Is Impacted How Other Providers Are Impacted Claim (transfer) • Episode record completed • Period End Date reflects claim “Through” date; • DOEBA is updated to reflect first visit date in episode • DOLBA is updated to reflect last visit date in episode • CWF uses the Period End Date as the end date of the admission period also. • An NOA will be accepted if the “From” date is on or after period “Through” date Claim Adjustment • No impact unless adjustment changes patient status to transfer or service lines are added or removed to change the DOEBA or DOLBA date. • No impact Claim Cancellation • The period is deleted from CWF unless an NOA indicator of 1 or 2 is present. • If an NOA indicator is present, the HIPPS code and DOEBA/DOLBA dates are removed but the period remains in the file. • No impact