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New Billing Requirements for Medicare Advantage Plans

July 21, 2014

Monica A. Motta, CPA

Effective with dates of service beginning July 1, 2014, the Centers for Medicaid and Medicare Services (CMS) is requiring Medicare Advantage plans to report Health Insurance Prospective Payment System (HIPPS) codes with all of their claims for care delivered to skilled nursing facilities and home health agencies.

Communications on how the plan will handle claims will come directly from the Medicare Advantage payers and not CMS.

What this means for you:

  • Most plans that previously paid by level of care will now require both the level of care revenue code and the HIPPS code information on claims.
  • Whereas previously you may not have done a Minimum Data Set (MDS) at admission on a resident expected to stay less than 14 days, you will now be required to prepare one for purposes of HIPPS coding on the bill.

Steps to be taken:

  • Check with contracted plans to see what their requirements will be.
  • Alert your MDS coordinators as to the new requirements to prepare them in completing assessments for Medicare Advantage residents, similar to what they are already doing for Medicare A patients.

For a copy of the memorandum dated May 23, 2014 sent from CMS to all Medicare Advantage Organizations (MAOs), PACE Organizations, Cost Plans and certain Demonstrations, click here.


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