- Avoiding Reason Code 38200
- Correcting Reason Code 37253
- Incarcerated or Unlawfully Present in the U.S. Claim Rejections (U538H, U538Q)
- Billing the Home Health Period of Care Claim - PDGM
- Disposable Negative Pressure Wound Therapy Services Under Home Health
- Home Health Prospective Payment System Booklet
- Home Health Third Party Liability Demand Billing
- Home Health Demand Billing
- Notice of Admission Questions and Answers
- Billing the Home Health Notice of Admission Electronically
- Billing the Home Health Notice of Admission via DDE
- Home Health Transfers
- Home Health Agency Transfer and Dispute Protocol
- Late Notice of Admission - The Exception Process
- Reporting Home Health Periods with No Skilled Visits
- Telehealth Home Health Services: New G-Codes
- Reporting Site of Service Codes for Home Health Care
- PDGM Resources
- Billing G-Codes for Therapy and Skilled Nursing Services
- Correcting and Avoiding Reason Code 38157: Duplicate Request for Anticipated Payment
- Correcting and Avoiding Reason Code C7080: Inpatient Overlap
- Completing the Advance Beneficiary Notice for Home Health Agency Demand Claims
- The Medicare Home Infusion Therapy Benefit and Home Health Agencies
- Home Health Therapy Billing
- Home Health Billing When a New MBI is Assigned
- 30-Day Home Health Therapy Reassessment Schedule
Home Health Transfers
Table of Contents
- Background
- What To Do As a Receiving HHA
- What To Do As the Initial HHA
- What To Do In Case of a Dispute
- Related Content
Background
A home health transfer occurs when a beneficiary elects to change from one HHA to another within an admission period. HHAs must work together to ensure a smooth transition from one agency to another.
What To Do As a Receiving HHA
- Inform the beneficiary the initial HHA will no longer receive Medicare payment on behalf of the patient and will no longer provide Medicare covered services to the patient after the date of the patient’s elected transfer.
- Document the beneficiary was notified of how the transfer will work and the payment implications.
- Check the patient’s eligibility to determine if the beneficiary is currently under an established plan of care with another HHA.
- Document in the record that you checked eligibility, e.g., screen print of the home health eligibility system.
- If the patient is under the care of another HHA, you must contact the initial HHA on the effective date of transfer to inform them of the transfer date.
- Document you contacted the other agency including:
- Who you talked to at the agency
- Date contacted
- Time contacted
- Submit an NOA with proper coding to indicate transfer from another HHA. Indicate transfer with condition code 47.
What To Do As the Initial HHA
- Document the receiving agency contacted you to inform you of the beneficiary transfer and that you accepted the transfer.
- Submit your final period of care claim with Patient Status Code ‘06’ to indicate transfer to another HHA.
What To Do In Case of a Dispute
In the instance of a dispute between HHAs, the initial HHA should contact the MAC to resolve the dispute. The MAC will work with both agencies to settle the dispute.
If the receiving HHA can provide documentation to support steps 1‐5 listed above were completed, the initial HHA will not receive payment for the period of overlapping dates in addition to receiving the partial period payment adjustment to their claim.
If the receiving agency cannot provide documentation to support appropriate transfer protocol, the receiving agency’s NOA and/or final claim will be canceled and full payment will be made to the initial HHA.
Related Content
Please review the Home Health Agency Transfer and Dispute Protocol job aid for more information on how to file a dispute.
- CMS IOM Publication 100-02, Medicare Benefit Policy Manual, Chapter 7, Section 10.8(E)
- CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 10, Section 10.1.13
Reviewed 5/20/2024