Home Health Billing Guidelines for Medicare Advantage

This guide outlines the billing procedures for home health services under Medicare Advantage, specifically for Humana plans. It details two primary reimbursement approaches: episodes of care, which follow the patient-driven groupings model (PDGM) established by the Centers for Medicare & Medicaid Services (CMS), and per visit, which operates on a fee-for-service basis. The document specifies that claims should be submitted using the CMS-1450 claim form or its electronic equivalent, with particular emphasis on reporting the PDGM determined by the Outcome and Assessment Information Set (OASIS). Additionally, it provides instructions for identifying the core-based statistical area and federal information processing standards codes. The guide also clarifies that Humana does not reimburse for Request for Anticipated Payment or Notice of Admission claims. Furthermore, it includes information on billing units based on the duration of patient visits, ensuring that healthcare providers adhere to the outlined billing practices.