CMS Publishes Home Health Agency Patient Transfer Updates

Good Morning MFS Bloggers, Due to the vast number of regulatory and reimbursement changes in the industry, more and more agencies are trandferring and thus, receiving, patients to/from thsir agency.

According to CMS, a transfer is described as a single beneficiary choosing to change HHAs during the same 60-day period.

During this transfer prociess, it is imperative that both HHAs work together.

I. Steps for the Receiving HHA:
• Check the Health Insurance Query (HIQH) for HHAs to determine if the beneficiary is currently under an established Plan of Care with another HHA. A patient status of “30” indicates that the patient is currently under an established plan of care. Therefore, regardless if whether or not the receiving agency is admitting a patient outside of the episode currently reflected in HIQH, the transfer requirements apply.
• Document in the record that you accessed HIQH by printing and stamping page 3 in HIQH.
• If the patient is under the care of another HHA:
– Contact the initial HHA to work out the transfer date.
– Document you contacted the other agency and include; who you talked to at the agency, date contacted and time contacted.
– Inform the beneficiary that the initial HHA will no longer receive Medicare payment on behalf of the patient and therefore, will no longer provide Medicare covered services to the patient after the date of the patients elected transfer.
– Document in the patient’s file that the beneficiary was notified of the transfer criteria and the possible payment implications.

II. Steps for the Transferring HHA:
– Document the receiving agency contacted you to inform you of the beneficiary transfer and that you accepted the transfer.
– Include the name of the person you spoke with at the agency, date, time and date agreed upon for the transfer to take place.
– Submit your final claim with Patient Status Code ‘06’ to indicate transfer to another HHA.

For a full explanation of CMS’s transfer guidelines, please refer to the Medicare Claims Processing Manual (PUB 100-02.)

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