Providers of home health services to Humana Medicare Advantage (MA) plan members must use the ASC X12 837I (“Institutional”) transaction (or, only when appropriate, the paper equivalent). The ASC X12 837I standard transaction is used by institutional health care providers, including home health agencies, to bill Original Medicare. Likewise, Humana’s MA plans require providers to submit all charges for home health services using the 837I transaction standard. (In the rare case that a paper submission is appropriate, the plan will permit a provider to submit charges using the paper equivalent of 837I, which is Form CMS-1450, also known as UB-04).
A Humana Medicare Advantage plan will deny charges for home health services submitted using an 837P (“Professional”) transaction standard or a paper CMS-1500 form because those formats are improper for home health services. In those cases, the provider may resubmit charges using an appropriate institutional format.
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