Home Health Claims Filing
The Fiscal Intermediary Standard System (FISS) Claims/Attachments option 26 (accessible from FISS Main Menu Option 02) allows you to enter home health Requests for Anticipated Payments (RAPs) and final claims. The following provides screen prints and field descriptions for each FISS claim page and identifies which fields are required for RAPs, final claims, and home health outpatient claims, and the data required in those fields. Information is also provided about specials claims filing situations.
For more information about the Home Health Prospective Payment System (HH PPS), go to the Home Health Prospective Payment System fact sheet, which is available on the Centers for Medicare & Medicaid Services (CMS) website, and the Medicare Claims Processing Manual (CMS Pub. 100-04, Ch. 10). In addition, please see the references on the CMS Home Health Agency (HHA) CenterWeb page, as well as the resources listed on the CGS Educational Materials & Resources webpage.
Note: Medicare makes a split percentage payment for most HH PPS episode periods. The first payment is in response to a processed RAP, and the last in response to a processed claim. If the claim is not received 120 days after the start date of the episode or 60 days after the paid date of the RAP (whichever is greater), the RAP payment will be canceled automatically by FISS and will be recouped. In order to receive payment, the RAP must be resubmitted and a final claim billed timely. For additional information, refer to section 40.1 of the Medicare Claims Processing Manual (CMS Pub. 100-04, Ch. 10), or the Top Claim Submission Errors for Home Health Providers: Error 38107 Web page.
There are six claim pages within FISS:
Special Claims Filing Situations
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