HOME HEALTH CLAIMS

[riafat]

Hi Michele,

I have some confessions about home health claims:

1-Why we used POS 11 (Office) when billing for home health claims (CPT G0180/G0179)?
2-Why we required to send "prior authorization number" for Home Health claims?
3-In which cases we need to send prior authorization number?

Riafat

[Michele]

1.  You use POS 11 for G0179 & G0180 since it is for the certification and recertification which is done by the dr, in the office.

2.  Many insurance carriers require preauth for home health services.  The preauth number must be on the claim.

3.  Any carrier that requires preauth, usually requires that the preauth number be on the claim.  There is no list of carriers, it depends on the plans in the area that the services were performed in.

Michele

[riafat]

Can you please educate me about certification and recertification period?

thanks for your response.


Riafat

[Michele]

Certification/recertification is:

Review of initial or subsequent reports of patient status

Review of the patient's responses to the Oasis assessment instrument

Contact with the home health agency to ascertain the initial implementation of the plan of care

Documentation in the patient's record


Michele

[riafat]

thanks

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