As a Medicare Advantage Managed Care Organization (MCO), AmeriHealth HMO, Inc. (AmeriHealth) 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, AmeriHealth 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 AmeriHealth 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 AmeriHealth 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 Hospital/Ancillary Services Coordinator or email CMS directly.