National Home Health Prospective Payment Episode History File

30.5 - National Home Health Prospective Payment Episode History File (Rev. 10758; Issued: 05-11-21; Effective: 01-01-22; Implementation: 08-11-21) CWF maintains a national history file for each beneficiary in order to enforce consolidated billing and perform HH PPS processing. 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. Only MACs, not providers, may view this file. The episode file, populated as soon as an admission period is opened for a beneficiary with an NOA, contains: • The beneficiary identifier; • Period Start and End Dates - the start date is received on an NOA or claim, and the end date is initially calculated to be the 30th day after the start date, changed as necessary when the claim for the period is finalized; • The pertinent A/B MAC (HHH), CMS Certification Number and National Provider Identifier; • The HRG Code - the HIPPS code used to determine payment for the period of care; • Date of Earliest Billing Activity (DOEBA) and Date of Latest Billing Activity (DOLBA) –line item dates of service of the first and last HH visits reported on the claim for the period of care; • Patient Status Indicator - the patient discharge status code on an HH PPS claim, indicating the status of the HH patient at the end of the period of care. • Cancellation Indicator – Indicates if the claim has been denied as fully non- covered by medical review. In these cases, the indicator is a value of “2.” In all other cases, the value is “0.” • NOA Indicator – Indicates the period was initially created by an NOA, not a claim. If the NOA is submitted as a transfer, with condition code 47, this indicator is set to ‘2.’ For any other NOAs, this indicator is set to ‘1.’ If a period is created by a continuing claim, this indicator is blank. The episode file contains the 36 most recent periods of care for any beneficiary. Periods that precede the most recent 36 will be dropped off the file and will not be retrievable online.