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Elizabeth M. Whitehorn, Director

In-Home Nursing Services Home Health Claims on Hold

HFS System Issue:

Home Health Claims with dates of service on or after 07/01/14 are temporarily placed on hold. At this time, the Department is requesting providers who bill for In-Home Shift Hourly Nursing Services do not submit claims to the Department for dates of service on or after July 1, 2014.

Problem:

As the result of a change in statute, rates for certain home health services are increasing effective 07/01/14. Rates for In-Home Shift nursing services, LPN or RN are subject to a 2.7% reduction. Providers who bill for In-Home Shift Hourly Nursing Services are asked to hold these claims to avoid overpayments and to allow for programming changes.

Providers Impacted:

Home Health Agencies and Home Nursing Agencies

Procedure Codes Impacted:

Problem Begin Date:

Claims with dates of service on or after 07/01/14

Problem Fix Date:

August 25, 2014

Resolution for Impacted Claims:

Providers should bill In-Home Shift Hourly Nursing Services using the reduced hourly rate reflected on the Home Health Fee Schedule, regardless of what is stated on the Prior Approval Notice. Providers will be receiving corrected Prior Approval Notices.

The fee schedule can be viewed at:

http://www.illinois.gov/hfs/MedicalProviders/MedicaidReimbursement/Pages/HHFeeSchedule.aspx