CMS Pub. 100-04, ch. 10, § 10.1.5.1

The primary HHA bills for all services furnished by both agencies and keeps all records

pertaining to the care and other HHAs serving the same beneficiary. Nonprimary HHAs

can receive payment under arrangement only from the primary HHA for services on the

plan of care where prior arrangement exists. The primary agency’s status as primary is

established through the submission, receipt and processing of a Notice of Admission

(NOA) for the home health care for the beneficiary. The secondary agency is paid

through the primary agency under mutually agreed upon arrangements between the two

agencies existing before the delivery of services for services called for under the plan of

care.

Two agencies must never bill as primary for the same beneficiary for the same admission

period. When the Common Working File (CWF) indicates an admission period is open

for a beneficiary, the A/B MAC (HHH) returns to the provider the NOA of any other

agency billing unless the NOA indicates a transfer or discharge and readmission situation

exists.

In rare cases, a Medicare beneficiary may receive an organ transplant and the organ

donor’s post-operative services are covered by the Medicare program. Since the donor is

frequently not a Medicare beneficiary, services for the donor are billed using the

Medicare beneficiary’s Medicare number. If both the organ recipient and organ donor

are receiving post-operative home health services, CWF cannot process HH PPS periods

for both patients for the same dates of service. In this case, the HH claim for the organ

recipient is accepted by CWF. The HH claim for the donor is processed by the A/B

MAC (HHH) outside CWF.