TriWest recently sent out a reminder to providers contracted under the VACCN network that skilled bundled home health services are reimbursed via the Medicare Patient-Driven Groupings Model (PDGM).
“These types of claims should be billed on a CMS UB-04 claim form using Type of Bill (TOB) 32X. The claim submission must include the VA referral number associated to a skilled bundled home health Standardized Episode of Care (SEOC).
Additionally, skilled unbundled (or non-bundled) services are reimbursed on a fee-for-services basis and can be billed on a CMS-1500 claim form using Place of Service 12, or a CMS UB04 claim form, using TOB 34X. The claim submission must include the VA referral number associated with a skilled unbundled SEOC.
Effective for dates of service Sept. 1, 2023 and after, skilled bundled home health services are rejected if the claim is not submitted with TOB 32X and if it is not submitted with a VA referral associated with a skilled bundled home health SEOC and includes TOB 32X.
Also, effective for dates of service Sept.1, 2023 and after, skilled unbundled home health services are rejected if not submitted with TOB 34X (CMS UB-04) or Place of Service 12 (CMS 1500) and if not submitted with a VA referral associated with a skilled unbundled home health SEOC.”
VACCN provider billing resources can be located at the following links Skilled Home Health Care Reference Guide v6 .pdf (vacommunitycare.com) and ccn-home-health-quick-reference-guide (triwest.com)
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