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Elizabeth M. Whitehorn, Director

In-Home Shift Hourly Nursing Services

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. The fee schedule can be viewed at:

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

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:

To be announced.

Resolution for Impacted Claims:

Providers will receive a remittance advice reporting the D04 error code – Suspended for Department Review – for those claims already billed to the Department and placed on hold. Please do not re-bill those services, as claims will be released once programming has been completed. Providers will receive another notice regarding how to properly bill these services. Please continue to access this site for updated announcements.