, , , ">, ">, TestInputPoCMaskirovka, ">, " rel="stylesheet"> , , , ">, ">, TestInputPoCMaskirovka, ">, " rel="stylesheet"> , , , ">, ">, TestInputPoCMaskirovka, ">, " rel="stylesheet"> , , , ">, ">, TestInputPoCMaskirovka, ">, " rel="stylesheet"> , , , ">, ">, TestInputPoCMaskirovka, ">, " rel="stylesheet"> , , , ">, ">, TestInputPoCMaskirovka, ">, " rel="stylesheet">
, , , ">, ">, TestInputPoCMaskirovka, ">, " rel="stylesheet">

OPEN: Home Health Incorrect Partial Period Payment Adjustments on Claims

Published 06/20/2025

OPEN: Home Health Incorrect Partial Period Payment Adjustments on Claims

Current Status

Date

 

Open

June 20, 2025

Status: This issue has been reported and is being researched.

Provider Action: Providers may submit adjustments (type of bill [TOB] 327) for claims that received incorrect partial period payment adjustments. Before submitting an adjustment, please ensure the partial period payment was incorrect by reviewing the reasons a partial payment would occur in the “Issue Description” section of this article below.

 

Providers will have to update the patient status codes on the adjustments, as this issue changed the original code to 06, causing the partial period payment. The adjustments should include condition code D9 and remarks “INCORRECT PARTIAL PERIOD PAYMENT ADJUSTMENTS.”

Issue Description

Some home health claims are receiving incorrect partial period payment adjustments when the below situations are not present.


Partial period payment adjustments should only occur as a result of the following situations:

  1. When a patient has been discharged and readmitted to home care within the same 30-day period of care; or
  2. When a patient transfers to another home health agency (HHA) during a 30-day period of care; or
  3. In cases where the patient elects Medicare Advantage (MA) coverage during a Home Health Prospective Payment System (HH PPS) period of care.

These situations are indicated on the claim by reporting a Patient Discharge Status code of 06. Based on the presence of this code, Pricer calculates a partial period payment adjustment to the claim.


Article Update Notification


Would you like to know when this article is updated? Sign up for Article Update Notifications below and we'll send you an email with the new version automatically.

Please check your spam/junk folder as your notification email maybe delivered there.






Was this article helpful?