New codes proposed for home health, hospice

At the National Uniform Billing Committee (NUBC) February meeting in Baltimore, representatives from the Health Care Financing Administration (HCFA) provided an update on the status of EMC V.6 revisions and presented requests for new billing codes for home health and hospice claims. Here is a summary of pertinent NUBC actions:

• The NUBC agreed on Jan. 6, 1999, to use "6" as a new electronic claims version in order to allow for expansion of the number of lines available on claims to 450. Information related to implementation of EMC V.6 is available on the HCFA Web site in the Program Memorandum section. HCFA announced that the effective date for implementation of V.6 is July 1, 2000.

HCFA received approval for addition of third-digit frequency codes to the NUBC manual. The third-digit frequency codes have longstanding use by HCFA but were never officially approved by the NUBC.

• The committee also approved HCFA’s request for a new Source of Admission Code effective Oct. 1, 2000, with implementation of the home health prospective payment. Code "C" will be used on the home health Notice of Admission in those cases where a patient has been discharged from a home health agency and is readmitted within the same 60-day period. A second request for a code to be used on the original 60-day final claim to indicate "discharged with treatment goals met, and readmitted within existing payment period" was deferred until further information can be gathered about its usefulness.

• The NUBC developed and approved a definition for "clean claim." This definition resulted from numerous requests from providers to establish a nationally acceptable definition that can serve as a standard to ensure prompt claims processing.

A clean claim has been defined as: "Absent a written definition that is agreed upon through contract, participation agreement, law, or regulation, the NUBC recommends that a clean institutional claim is a properly completed billing instrument [paper and electronic] that consists of the UB-92 data set, or its successor, submitted on the designated paper or electronic formats as adopted by the NUBC with entries stated as mandatory by the NUBC, along with any state-designated data requirements determined and approved by the state uniform billing committee and included in the UB-92 manual effective at the time of service. It does not involve coordination of benefits (COB) for third-party liability or subrogation as evidenced by the information provided on the claim related to COB."