Home health providers not contracted with Humana Medicare must use Form CMS 1450. Form CMS 1450, the UB-04, is used by institutional health care providers, including home health agencies, to bill Original Medicare. Likewise, Humana’s Medicare Advantage (MA) plans require health care providers without contracts to submit all home health services on Form CMS 1450 (or the electronic transaction equivalent).
Unless it is submitted by a health care provider specifically contracted for Form CMS 1500, a Humana Medicare Advantage plan will deny home health services submitted on Form CMS 1500, because the submission of the form was improper. Humana will require the health care provider to resubmit charges for those services on Form CMS 1450 (or the electronic transaction equivalent).
Additional CMS billing requirements for home health include, but are not limited to, the following.
- Submitting the home health resource group (HHRG) with revenue code 023
- Submitting the treatment authorization code (TAC), which is obtained through the Medicare OASIS system
- Submitting the core-based statistical area (CBSA) where services were rendered (submitted with value code 61)
- Using an appropriate home health prospective payment system (PPS) bill type
- Billing each visit on a separate claim line
- Billing each visit with the appropriate CMS-designated revenue and Healthcare Common Procedure Coding System (HCPCS) code combinations
- Billing units appropriate for the description of the HCPCS code (e.g., CMS visit G-codes represent 15-minute increments of service)
- Billing a claim line for nonroutine supplies (NRS) when the HHRG indicates NRS were provided
- Billing CMS-required informational Q-codes