CMS Pub. 100-04, ch. 10, § 30.11

on the HH PPS Episode File

(Rev. 10758; Issued: 05-11-21; Effective: 01-01-22; Implementation: 08-11-21)

The following chart summarizes basic effects of HH PPS claims processing on the

episode record. Even though under the PDGM, the HH unit of payment is a 30-day

period of care, this file continues to be named ‘the episode file’ in CWF and references to

‘episode record’ below refer to periods of care.

Transaction How CWF Is Impacted How Other Providers Are Impacted

NOA • Opens an episode record

using NOA “From” date to set

Period Start Date

• CWF uses Start Date to

calculate admission period

• Period End Date is

automatically calculated to

extend through 30th day

• DOEBA and DOLBA are left

blank

• NOA indicator is set to 1

• Other NOAs submitted during this

open admission period will be rejected

unless an indicator of a transfer or

discharge/readmission is present

NOA with

condition

code 47

• Opens an episode record

using NOA’s “From” date to

set Period Start Date

• Period End Date is

automatically calculated to

extend through 30th day

• DOEBA and DOLBA are left

blank

• The Period End Date (if later

than the NOA “From” date) is

automatically changed to

reflect the NOA’s “from”

date.

• NOA indicator is set to 2

• CWF uses the new Start Date

as the end date of the previous

admission period.

• The Period End Date created by the

NOA or claim of the HHA the

beneficiary is transferring from is

automatically changed to reflect the

"from" date on the NOA submitted by

the HHA the beneficiary is transferring

to. The HHA the beneficiary is

transferring from cannot bill for

services past the date of transfer.

• Another HHA cannot bill during this

episode unless another transfer NOA is

submitted.

Transaction How CWF Is Impacted How Other Providers Are Impacted

NOA

Cancellation

by Provider

(TOB 032D)

• The episode record is deleted

from CWF

• No episode record is present to prevent

NOA submission by another provider,

making that provider the primary HHA

for the dates of the episode

Claim (full

30-day

period,

patient status

30)

• 30-day record is completed

• Period End Date remains at

the 30th day

• DOEBA is updated to reflect

first visit date in period

• DOLBA is updated to reflect

last visit date in episode

• CWF considers the admission

period still open.

• Other NOAs submitted during this

open period will be rejected unless an

indicator of a transfer or

discharge/readmission is present

Claim

(discharge

with goals

met prior to

Day 30)

• 30-day record is completed

• Period End Date remains at

the 30th day;

• DOEBA is updated to reflect

first visit date in episode

• DOLBA is updated to reflect

last visit date in episode

• CWF uses the Period End

Date as the end date of the

admission period also.

• Other NOAs submitted with “From”

dates before the end date of this period

will be rejected unless an indicator of a

transfer or discharge/readmission is

present

Transaction How CWF Is Impacted How Other Providers Are Impacted

Claim

(transfer)

• Episode record completed

• Period End Date reflects

claim “Through” date;

• DOEBA is updated to reflect

first visit date in episode

• DOLBA is updated to reflect

last visit date in episode

• CWF uses the Period End

Date as the end date of the

admission period also.

• An NOA will be accepted if the

“From” date is on or after period

“Through” date

Claim

Adjustment

• No impact unless adjustment

changes patient status to

transfer or service lines are

added or removed to change

the DOEBA or DOLBA date.

• No impact

Claim

Cancellation

• The period is deleted from

CWF unless an NOA

indicator of 1 or 2 is present.

• If an NOA indicator is

present, the HIPPS code and

DOEBA/DOLBA dates are

removed but the period

remains in the file.

• No impact