Point32Health has developed a new, integrated Payment Policy for Inpatient Hospital Admissions, which is replacing the previous legacy Harvard Pilgrim Health Care Inpatient Acute Medical Admissions and Tufts Health Plan Inpatient Facility policies.
The new policy contains additional clarifying information and billing instructions for hospital at home care, an alternative delivery model administered by the hospital for care of acutely ill members who are stable enough to have hospital level of care safely provided at home, which Point32Health reimburses for contracted providers when medically necessary.
When submitting claims for hospital at home services, report revenue code 0161 (hospital at home, room and board/hospital at home), unless otherwise indicated in your provider agreement. Occurrence span code 82 (hospital at home care dates) will be used to track the from and through dates of the hospital at home care delivered during an inpatient stay.
As a reminder, related ancillary services rendered in the home — such as ambulance, skilled nursing and rehabilitation services, infusion services, and lab and radiology services — are included in the DRG payment. They should not be billed separately and may be subject to random post-payment audits and retraction.
Please refer to the Inpatient Hospital Admissions Payment Policy for complete billing and reimbursement information. In addition, Point32Health has developed Medical Necessity Guidelines for Acute Hospital Care at Home, which outline clinical coverage criteria and notification requirements.