As a Medicare Advantage Managed Care Organization (MCO), IBC is required to
meet the standards set by the Centers for Medicare & Medicaid Services (CMS).
Recently, information was received from CMS regarding specific requirements on
when Health Insurance Prospective Payment System (HIPPS) codes should be
included on Skilled Nursing Facility (SNF) and Home Health Agency (HHA)
claims/encounters that are sent to CMS.
Services that require HIPPS codes
Effective July 1, 2014, IBC will be required to submit HIPPS codes to CMS for
certain SNF and HHA claims/encounters as outlined below:
SNF. Claims/encounters that come from the initial Omnibus Budget Reconciliation
Act (OBRA)-required comprehensive assessment (Admission Assessment).
HHA. Claims/encounters that come from the initial Outcome and Assessment
Information Set (Start of Care Assessment) or OASIS.
How this affects providers
In order for IBC to meet this CMS requirement, SNF and HHA providers are
required to include the proper HIPPS codes on their 837-Institutional claim
forms submitted to IBC for any claims/encounters that meet the criteria above
where the ?from? date is on or after July 1, 2014. Failure to include the
appropriate HIPPS codes will cause your claims to reject.
We appreciate your compliance in this matter. If you have any questions about
this requirement, please contact your Network Coordinator or
email CMS
directly.