HH Billing - DSL Sacramento

The Notice of Admission (NOA) must be submitted within what timeframe to avoid financial penalty?

• Within 5 business days of the start of care

• Immediately before billing the period of care claim

• Within 5 calendar days of the start of care

• There’s no specific timeframe to submit the NOA

What does the acronym PDGM stand for?

• Payment Driven Grouping Model

• Patient Decided Grouping Model

• Patient Driven Groupings Model

• Payment Domain Group Modeling

The NOA can be adjusted to fix errors.

• True

• False

Answer explanation

The NOA cannot be adjusted. It must be canceled and resubmitted

The NOA needs to be submitted at the beginning of every 30-day period of care.

• True

• False

Answer explanation

The NOA is only submitted when there is a new HH admission and remains effective until the patient is transferred or discharged.

What requirement must be met prior to billing the NOA?

• The physician’s verbal or written order containing services required for an initial visit have been received and documented

• The HHA has conducted the initial visit

• The patient has been admitted to home health care

• All of the above

What code should an HHA use to open a new admission for a transferred patient?

• Occurrence code 50

• Condition code 47

• Condition code 54

• Value code 61

What are the appropriate bill types that can be submitted for the NOA?

• Bill types 329 & 327

• Bill types 322 & 320

• Bill types 32A & 32D

• Bill types 32A & 328

A home health agency is responsible for billing all services provided a patient, regardless of whether they were provided directly or under arrangements.

• True

• False

Answer explanation

The HHA can contract with outside providers to provide care for the patient for services under the plan of care; however, all services must be submitted on one claim by one home health agency

The home health PPS payment is based on:

• The HIPPS code submitted on the claim

• The data submitted on the NOA

• The HIPPS code assigned by the claims processing system

• None of the above

The certification and plan of care are based on 60 days and billing is done every 30 days.

• True

• False

Answer explanation

Even though the certification/recertification, OASIS, and plan of care are based on 60 days, the period of care claims are based on 30 day periods.