Episodic Payment System for Certified Home Health Agencies

Billing Update Regarding Medical Orders - October 10, 2012

In response to a request from CHHA providers to help address potential cash flow disruptions as a result of delays in the receipt of written medical orders, the Department has changed its requirements related to the receipt of medical orders and diagnoses and the submission of "Interim Claims" under the CHHA Episodic Pricing System.

If a physician-signed plan of care is not available at the beginning of the episode, the CHHA may submit an "Interim Claim" based on verbal orders from the authorized practitioner. Such verbal orders must be recorded in the plan of care; must include a description of the patient's condition and the services to be provided by the CHHA; and must include an attestation consistent with the attestation required in accordance with federal Medicare regulations at 42 CFR 409.43.

Consistent with NYCRR Title 10, Section 763.7, written orders must be obtained by the CHHA within 30 days after admission to the agency, or prior to submitting a "Final Claim" for episodic reimbursement, whichever is sooner.

The acceptability of "Interim Claims" based on verbal orders, subject to the conditions described above, is retroactive to May 1, 2012, which was the effective date for the Episodic Payment System.

This change will have no effect on non-episodic claims submitted by CHHAs. In these situations, written orders are required before billing or within 30 days of admission, whichever is sooner.

This notice will supersede Item #2 (Medical Orders) in the following document which was previously distributed to providers:

Additional Billing Guidance as of July 1, 2012

Questions regarding this information may be submitted to the following address: bltcr-ch@health.state.ny.us