Good Afternoon MFS Bloggers, I recently came across this very informative RHHI memo on transfers. Given the fact that CMS nor the RHHI has posted anything recently on the prevalent issue of patient transfers, I thought it would be a good idea to post a blog with the informaiton. Happy reading!!
What is a Transfer? A transfer is described as a single beneficiary choosing to change home health agencies (HHAs) during the same 60-day period. It is imperative that HHAs work together during a transfer situation.
Steps for the Receiving Home Health Agency:
• Check the Health Insurance Query for HHAs (HIQH) to determine if the beneficiary is currently under an established plan of care with another HHA.
• Document in the record that you accessed HIQH by printing and date stamping page 3.
o 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 the name of the person you spoke with and the date and time of contact.
• 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 patient’s elected transfer. Document in the patient’s file that the beneficiary was notified of the transfer criteria and the possible payment implications.
• Submit your Request for Anticipated Payment (RAP) with source of admission code ‘B’ to indicate transfer from another HHA.
Steps for the Initial Home Health Agency:•
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 transfer to take place.
• Submit your final claim with Patient Status Code 06′ to indicate transfer to another HHA.
What should you do if there is a dispute?
Should a dispute arise, both agencies should try to work out the issue between them prior to calling the Fiscal Intermediary. In the instance when a resolution cannot be made then the initial HHA should contact the Palmetto GBA Provider Contact Center at (866) 801-5301. Palmetto GBA will work with both agencies to settle the dispute however, certain information will need to be provided.
If the receiving HHA can provide documentation to support the bullets listed under Steps for the Receiving Home Health Agency above were completed, the initial HHA will not receive payment for the period of overlapping dates in addition to receiving the Partial Episode Payment (PEP) adjustment to their claim.
If the receiving agency cannot provide documentation to support an appropriate transfer was completed, the receiving agency’s Request for Anticipated Payment (RAP) and/or Final Claim will be canceled and full payment will be made to the initial HHA.
NOTE: To obtain information in regards to Home Health Overlaps, please refer to the How to Avoid Overlapping Home Health Episodes job aid at www.PalmettbGBA.com/rhhi
