2013 Practitioner and Provider Manual - Presbyterian Healthcare ...

Home HealthPatient Care ConferencesMonthly patient care conferences will be conductedby telephone. PHHSN quality review nurses willidentify those patients who will benefit from a careconference. Identification of these patients is basedupon complexity of the case, need for coordinationwith other health care providers, patients utilizinggreater than 20 visits within a prior authorizationperiod, or patients with recidivism to the hospital orhome care.Participants in the care conferences may be aPHHSN quality review nurse, a member of agencystaff, a physician, or other health care providers.The PHHSN quality review nurse will completedocumentation of care conferences and results onthe case-conference report. The case-conferencereport will be faxed to the agency with a copymaintained in the PHHSN patient’s record andcase-conference review files.Claims ProcessingThe agency should submit all claims on a UB-04form, completing all fields in accordance withstandard home health billing requirements. Pleaserefer to the Claims and Payment chapter of thismanual for detailed information on the claimssubmission processes and policies. The followingrevenue codes should be used:Claims Processing Revenue CodesDescriptionRevenue CodeRN visit 0551Dietitian visit 0581Claims Processing Revenue CodesDescriptionRevenue CodePhysical therapy visit 0421Occupational therapy visit 0431Speech therapy visit 0441Social worker visit 0561Home health aide visit 0571Supplies 0270RN per hour 0550LPN per hour 0580PCA per hour 0590HHA per hour 0570Please keep in mind the following when submittingclaims:Attach an itemized supply list to the UB-04when billing under Revenue Code 0270.Record accurate federal tax identificationnumber on the UB-04 under form Locator #5.Record the prior authorization/benefitcertification number on the UB-04 under formLocator #63; it is not necessary to attach ahard copy of the approval to the claim.Ensure that all claims contain the agency’sNational Provider Identifier number and thecorrect taxonomy code.Ensure that the correct ICD9 Code is used.When billing EPSDT long-hour care, the timemust be billed in 15-minute increments. Whenservices go over or under 15 minutes, the11-102014 Practitioner and Provider Manual - Ver. 3