Industry Insights

2016 Home Health & Hospice CBSA Codes Have Changed:  Do You Know Your Codes?

April 2016
Author:  Elizabeth Wilson

Elizabeth Wilson

Managing Consultant

Consulting

Health Care

910 E. St. Louis Street, Suite 200
P.O. Box 1190
Springfield, MO 65801-1190 (65806)

Springfield
417.865.8701

The Centers for Medicare & Medicaid Services (CMS) has been transitioning the core-based statistical area (CBSA) designations during 2015 and 2016 for both home health and hospice agencies. These transitions resulted in a blended wage index adjustment and the possible assignment of temporary “50xxx” CBSA codes for affected counties or parishes during the transition year. Since CBSA codes are used in determining the wage-index adjustment applied to home health and hospice payments, it is critical to verify claims are billed with the code that correctly identifies the county or parish where the patient’s care was delivered.

Home Health

The home health transition occurred in calendar year 2015. Home health agencies providing services in a county or parish with a 2015 transitional code should use the temporary “50xxx” code when submitting requests for anticipated payment for episodes beginning prior to January 1, 2016. If the episode ends January 1, 2016, or later, the final claim should be submitted with the 2016 CBSA code assigned to that county or parish. The temporary “50xxx” CBSA codes are no longer in effect for episodes beginning and/or ending in 2016.

You can download home health CBSA designations and payment rates on our website.

Hospice

The hospice transitional year corresponds to the federal fiscal year (FFY) beginning October 1, 2015, and ending September 30, 2016. Hospice agencies providing services in a county or parish with an FFY 2016 transitional code should use the temporary “50xxx” code when submitting claims for dates of service October 1, 2015 - September 30, 2016. The temporary “50xxx” CBSA codes will no longer be used for claims beginning October 1, 2016.

You can download hospice CBSA designations and payment rates here.

For more information, contact your BKD advisor.

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