Medicare Home Health Billing: Dealing with Duplicate Claims

Medicare home health billing is a complicated and very specialized process. There are frequent changes in billing regulations which makes home health reimbursements a real nightmare sometimes. Home health billing is a logical process with many checks and balances; however, errors are not uncommon and often result in denied claims and lost revenue amounting to billions of dollars every year for home health agencies. More often than not, duplicate entries cause compliance issues and considerably slow down the billing process.

Understanding the Medicare home health billing system is the key to getting proper reimbursement. Don’t let duplicate claims wreak havoc on your reimbursements. Follow these simple steps to avoid some common home health billing mistakes:

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Incorrect Information: Conflicting information on the Request for Additional Payment (RAP) and final claim can compromise your reimbursement. The admission date and Health Insurance Prospective Payment System (HIPPS) code are two frequent culprits, or the Health Insurance Claim Number (HICN) may have been corrected.

Cancels: If you submit incorrect information on a RAP, you must cancel the RAP and submit a new one.

Autocancels: If the claims system auto-cancelled your RAP because you took too long to submit a final claim, it isn’t entirely erased from the Common Working File (CWF).

Adjustments: When two final claims have been submitted, HHAs should submit an adjustment (type of bill 3X7) instead of a duplicate final claim to fix errors.

Hold Off: Submitting a second RAP will not help if your claim was rejected. Instead, send the relevant materials to the correct department at the Regional Home Health Intermediary (RHHI), and it will determine how to process the RAP.

Make yourself aware of the Medicare home health billing complexities and analyze your entire billing data for any opportunity that you can lay reimbursement claim upon.

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