Episodic Payment System for Certified Home Health Agencies
Billing Update Regarding Assessment Dates - August 29, 2012
Programming changes have been completed in the eMedNY billing system to allow the use of OASIS assessment dates that are up to 65 days prior to the episode start date for Certified Home Health Agency episodic claims.
The previous limit for the assessment date, which must be reported with Occurrence Code 50 for all CHHA episodic claims billed with rate codes 4810 through 4917, was 60 days prior to the episode start date. The change to 65 days is effective retroactive to May 1, 2012, when the episodic payment system was implemented.
If a provider wishes to submit an episodic claim at this time with an assessment date that is 61-65 days prior to the episode start date, and if the end date of the episode is more than 90 days prior to claim submission, the provider may use Delay Reason Code 3 (Authorization Delays) to successfully submit the claim.
Authorization to use Delay Reason Code 3 for this purpose will expire 30 days from the date of this notice. Providers will be expected to file all claims on a timely basis after that period.
As noted in the "Additional Billing Guidance" issued to providers on July 1, 2012, the range of acceptable assessment dates was expanded as of July 1 (retroactive to May 1) to include dates up to 5 days after the start date of the episode. With the most recent revision, the acceptable range is now from 65 days prior to the start date, to 5 days after the start date. If there is more than one assessment available in this date range, the most recent assessment should be used.
Questions regarding this information should be directed to the following email address: firstname.lastname@example.org