Opening and Length of HH PPS Episodes/Periods of Care

30.6 - Opening and Length of HH PPS Episodes/Periods of Care (Rev. 10758; Issued: 05-11-21; Effective: 01-01-22; Implementation: 08-11-21) Within CWF, the episode history auxiliary file is separate from the home health benefit period auxiliary file (labeled HHEH), which existed prior to HH PPS and is used to administer payment of HH services from the correct Medicare Trust Fund. All HH PPS claims update both these files. NOAs only update the episode history file. The initial 30-day period of care is created on this file based on the NOA. The start date of this period of care is also used to indicate the start date of an HH admission period. The HH admission period is a claims processing concept used to correctly enforce primary HHA assignment and HH consolidated billing. Medicare systems determine a claim to fall within an HH admission period if it is within an admission period start and end date OR if it is on or after the start date of a period that remains open. Medicare systems determine the span of an admission period from HHEH period information as follows: Admission Period Start Date: The HHEH Period Start Date when the NOA indicator is 1 or 2. Admission Period End Date: • The HHEH Period End Date when the patient status on latest HHEH period in a series of contiguous periods indicates a discharge (the code is other than 30), or • The HHEH Start Date of a subsequent HHEH period when the NOA indicator on the subsequent period is 1 or 2. If an NOA with a different provider number falls within an admission period and does not report a transfer using condition code 47, the NOA will be returned to the provider because the HHA is not the primary HHA for that beneficiary. If a claim subject to HH consolidated billing falls within an admission period, but does not fall within dates that reflect an HH claim has been paid, the claim will receive an alert as described in section 20.2.5. The initial 30-day period of care created by the NOA is updated by the claim for that period. All subsequent periods of care in the admission will be created by the subsequent claims. Multiple periods can be open for the same beneficiary at the same time. The same HHA may require multiple periods be opened for the same beneficiary because of an unexpected readmission after discharge. Multiple periods may also occur between different providers if a transfer situation exists. CWF will post NOAs received with appropriate transfer and readmit indicators to facilitate the creation of multiple periods. Same day transfers are permitted, such that a period of care for one agency can end on the same date as a period of care was opened by another agency for the same beneficiary. Both HHA’s services for this date will be approved for payment, without regard for whether the same HH disciplines (e.g. skilled nursing, physical therapy, etc.) from both HHAs provided services. When periods of care are created from NOAs, CWF calculates a period end date that does not exceed the start date plus 29 days. CWF will assure no period exceeds the maximum length under any circumstance, and will auto-adjust the period end date to shorten the period if needed based on subsequent NOA or claim submissions (i.e., shortened by transfer).