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Home Health Billing Requirements – Reminder

Posted on Friday, February 8, 2019 2:36 AM

Starting on January 1, 2019, new billing requirement Change Request 10782, requires that home health agencies put value code 85 on all claims, not just rural claims.  CMS clarified this in a Home Health, Hospice & DME/Quality Open Door Forum on November 14, 2018.  Specifically, CMS stated, “…home health agencies should be aware that claims for episodes ending in 2019 must include the new value code 85 and report the FIPS state and county code for the beneficiaries, residents in the associated value amount. Based on the questions I received so far, these are some key points to know. Value code 85 must be reported on all Home Health PPS claims not just rural claims. This is required by the law. Both value code 61 which reports the CBSA code for the beneficiary and value code 85 are required. Value code 61 will continue to be used to (weight) adjust the home health agency’s payment. Value code 85 will be used to determine the category of rural add-on that applies. When value code 85 is not on the claim for use in rural payment calculations, the claim will be returned to their provider, so they can add the code and resubmit.”

This is a reminder to home health agencies that ALL claims, whether rural or not, must include the value code 85 and corresponding FIPS code. 

Source: NAHC


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