Update on Developing Uniform Billing Codes for Home Care

LeadingAge NY and other associations continues meeting with the Department of Health (DOH) on developing uniform/standard billing codes with modifiers for home care providers submitting managed care claims. We have asked our home care members for examples of the current codes in use and then cross-walked those codes with the Health Care Common Procedure Codes (HCPCS) used by managed care plans in their encounter data reporting. Our analysis includes codes for multiple levels of personal care, home health aides, consumer directed personal assistance program, telehealth and adult day health care programs.

We have also completed developing a proposed coding logic for the three 1915 (c ) waivers, Long Term Home Health Care Program (LTHHCP), Traumatic Brain Injury (TBI) and the Nursing Home Transition and Diversion (NHTD) Medicaid waivers, with standardized coding between the three waiver programs wherever common services exist.

The next step in the process of developing uniform billing codes will be to present the proposed system to DOH who then will seek managed care plan review.  Then another step in the process will be for the home care associations, plan representatives and DOH to iron out any remaining issues to develop a consensus on the codes.

This initiative originated in part from the DOH Home and Community-based Care work group and then became part of this year’s final State budget which requires implementation of uniform billing/coding standards for home and community-based services and nursing home claims, effective Jan. 1, 2016. It also requires plans to pay electronic claims from these providers via electronic funds transfers.

LeadingAge NY is working closely with our HCBS and PACE/MLTC Cabinets on this issue and will keep members posted on any further developments.  Our Nursing Home Cabinet was also involved in the development of their relevant codes sets.

Contact: Cheryl Udell, cudell@leadingageny.org, 518-867-8871 or Patrick Cucinelli, pcucinelli@leadingageny.org, 518-867-8827.