All rights reserved. endstream endobj 5547 0 obj <. AMA disclaims responsibility for any errors in CPT that may arise as a result of CPT being used in conjunction with any software and/or hardware system that is not Year 2000 compliant. Providers should use "Condition Code 47" to replace Point of Origin for Admission or Visit Code "B." %%EOF Guidance for updates to the Point-of-Origin for Admission or Visit Codes to the UB-04 (CMS-1450) Manual Code List. Any communication or data transiting or stored on this system may be disclosed or used for any lawful Government purpose. Care or Enrolled in a Hospice Program. Patient discharged as no longer terminally ill; or. License to use CDT for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago IL 60611. 0000003247 00000 n Print | Access the claim through DDE using the Claims Inquiries menu option 02 from the main menu. If the item you need to change is medically denied (e.g., remark code MA01: file an appeal using the CGS. 0000090312 00000 n Required except for Bill Type 014X, (the bill type is used for non-patient laboratory specimens and the point of origin would not be known). Get quick access to MLN Matters national provider education articles that help you understand new or revised Medicare policy and . All Rights Reserved. To license the electronic data file of UB-04 Data Specifications, contact AHA at (312) 893-6816. . incorporated into a contract. If you need assistance accessing an accessible version of this document, please reach out to the guidance@hhs.gov. This information will be reviewed and used in the pricing of the unassigned drug(s). Hierarchical Condition Category Coding | AAFP on the guidance repository, except to establish historical facts. 0000124474 00000 n You must ensure, based on the year of your claim, that the appropriate modifiers are present on the claim so that it may process correctly. If you do not agree to the terms and conditions, you may not access or use the software. To request permission to reproduce AHA content, please, Official UB-04 Data Specifications Manual, NUBC Comment Letter on Attachments Proposed Rule, Letter from the NUBC to HHS regarding the Attachments Proposed Rule, Meeting Agenda for NUBC Meeting April 11 and 12, 2023, NUBC Letter to NCVHS on behalf of DSMOs 10.3.2022, Letter regarding Appropriate Use Criteria (AUC), The NUBC has approved two codes used in claims for hospital-at-home care. License to use CPT for any use not authorized here in must be obtained through the AMA, CPT Intellectual Property Services, 515 N. State Street, Chicago, IL 60610. Clinic referral The patient was admitted upon the recommendation of this facility's clinic physician. This code has been discontinued. Non-Health Care Facility Point of Origin (Physician Referral) Usage note: Includes patients coming from home, a physician's office, or workplace. When using the D9 condition code, the adjustment reason must be entered in the Remarks field. You, your employees and agents are authorized to use CPT only as contained in materials on the Texas Medicaid & Healthcare Partnership (TMHP) website solely for your own personal use in directly participating in healthcare programs administered by THHS. Surgical Center; and F, Transfer from Hospice and is Under a Hospice Plan of The AMA does not directly or indirectly practice medicine or dispense medical services. HCPCS code C9399 should be reported as follows: When billing the applicable information for the unassigned drug on Page 2 in Direct Data Entry (DDE), providers should report one drug per revenue line. 2. Medicare Claims Processing Manual (Pub.100-04), chapter 32, section 69. This CR also directs Medicare systems changes for code 7. Even though the decision to admit was not made by the other facility, the patient was still seen by the other facilitys emergency room personnel and a decision to transfer was made by them. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials. Each alpha character, except for "X", represents an origin code or a destination code. U.S. Department of Health & Human Services Note: The information obtained from this Noridian website application is as current as possible. Users must adhere to CMS Information Security Policies, Standards, and Procedures. Unauthorized or illegal use of the computer system is prohibited and subject to criminal and civil penalties. National Uniform Billing Committee (NUBC) Point of Origin Code Updates | Guidance Portal Return to Search National Uniform Billing Committee (NUBC) Point of Origin Code Updates This instruction provides point of origin code updates Download the Guidance Document Final Issued by: Centers for Medicare & Medicaid Services (CMS) License to use CPT for any use not authorized herein must be obtained through the American Medical Association, Intellectual Property Services, 515 N. State Street, Chicago, Illinois, 60610. %PDF-1.7 % %%EOF You may also contact AHA at ub04@healthforum.com. This Agreement will terminate upon notice to you if you violate the terms of the Agreement. System Update. Also, Point of Origin for Admission or Visit code '2' definition language has been updated, though the processing of code '2' is not being changed. U.S. Department of Health & Human Services For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413. 0000002938 00000 n Issued by: Centers for Medicare & Medicaid Services (CMS). Court/law enforcement The patient was admitted upon the direction of a court of law or upon the request of a law enforcement agency's representative. Visit Code. Code Structure. 0000005131 00000 n U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2)(June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a)(June 1995) and DFARS 227.7202-3(a)June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department Federal procurements. For example, reason code C7251 will appear as the claim denial when the LIDOS of an outpatient claim (e.g., 12X, 13X, 14X, 22X, 23X, 34X, 74X, 75X, 83X and 85X) overlaps with a Part A skilled nursing facility (SNF) inpatient claim (21X) or when the outpatient claim LIDOS overlaps with an inpatient Part B (22X) claim. The Point of Origin code would be Code 4 Transfer from a Hospital (Different Facility) due to the patient being seen at the other acute care facilitys emergency room. Applications are available at the American Medical Association website, www.ama-assn.org/go/cpt. 0000003530 00000 n In the CY 2021 MPFS proposed rule, CMS points to the method of valuation (i.e. Instead, the patient is transferred immediately to the Heart Catheterization Department of our facility, the Point of Origin code would still be 4. Home Health Medicare Billing Codes Sheet Washington, D.C. 20201 The following information must be included on the claim: When a hospital utilization review committee determines inpatient admission does not meet criteria, the hospital may change the beneficiary's status from inpatient to outpatient. The .gov means its official. 0000002620 00000 n The scope of this license is determined by the AMA, the copyright holder. Reference: CMS MLN Matters article MM6801, "Point of Origin for Admission or Visit Codes Update to the UB-04 (CMS-1450) Manual Code List" CGS maintains a Claims Processing Issues Log on our website. hb```f ! 0000079263 00000 n License to use CPT for any use not authorized here in must be obtained through the AMA, CPT Intellectual Property Services, 515 N. State Street, Chicago, IL 60610. CMS Medicare Financial Management Manual (Pub. All Rights Reserved (or such other date of publication of CPT). LICENSE FOR NATIONAL UNIFORM BILLING COMMITTEE ("NUBC"), Point and Click American Hospital Association Copyright Notice, Copyright 2021, the American Hospital Association, Chicago, Illinois. Washington, D.C. 20201 Is there a limit to the number of claims that can be seen in the return to provider (RTP) status? 0000123802 00000 n Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the American Medical Association (AMA) is not recommending their use. How can we receive payment for therapy in this case? Point of Origin Codes Update to the UB-04 (CMS-1450) Manual Code List Suppressed claims are excluded from this count. Transfer from hospital inpatient in the same facility resulting in a separate claim to the payer The patient was admitted to this facility as a transfer from hospital inpatient within this facility resulting in a separate claim to the payer. Point of Origin Code Change and Update | TMHP Unauthorized or improper use of this system is prohibited and may result in disciplinary action and/or civil and criminal penalties. Point of Origin Codes Update to the UB-04 (CMS-1450) Manual Code List Use of CDT-4 is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). Example: The site is secure. BY ACCESSING AND USING THIS SYSTEM YOU ARE CONSENTING TO THE MONITORING OF YOUR USE OF THE SYSTEM, AND TO SECURITY ASSESSMENT AND AUDITING ACTIVITIES THAT MAY BE USED FOR LAW ENFORCEMENT OR OTHER LEGALLY PERMISSIBLE PURPOSES. 0000006870 00000 n 0000079290 00000 n 5. CMS Medicare Learning Network (MLN) Published 07/01/2017. 0000000016 00000 n 0000016000 00000 n CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CDT-4. Email | How do I bill for services we provided to him? 0000090525 00000 n AS USED HEREIN, "YOU" AND "YOUR" REFER TO YOU AND ANY ORGANIZATION ON BEHALF OF WHICH YOU ARE ACTING. Transfer from a skilled nursing facility (SNF) or Intermediate Care Facility (ICF) The patient was admitted to this facility as a transfer from a SNF or ICF where he or she was a resident. on the guidance repository, except to establish historical facts. Any questions pertaining to the license or use of the CPT must be addressed to the AMA. The AMA warrants that due to the nature of CPT, it does not manipulate or process dates, therefore there is no Year 2000 issue with CPT. DISCLAIMER: The contents of this database lack the force and effect of law, except as Ensure you are capturing the complete DCN. 5546 0 obj <> endobj Federal government websites often end in .gov or .mil. If the dates of service are within the home health episode, you will need to contact the home health agency to set a contractual arrangement for reimbursement. Code 7 also includes self-referrals in emergency situations that require immediate medical attention. 0000008613 00000 n The Fiscal Intermediary (FI) will pay 80 percent of that calculated payment to the hospital; beneficiaries will be responsible for the 20 percent co-insurance after the deductible is met. The types of admissions are valid with Point of Origin code "G" as follows: The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. Normal delivery A baby delivered without complications. The ADA expressly disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. Reason code (RC) 30902 is applied to an adjusted claim when the cross-reference (x-ref) document control number (DCN) does not match with the original claim that is being adjusted. 2'Os+'EGm 7=X $E;OS*:Uf`I)7C54J[BCMCC2b# DHzcP,QIU*y`ej To sign up for updates or to access your subscriber preferences, please enter your contact information below. << Previous Data Element X12-837 Input Table of Contents Next Data Element >> Questions or comments: sparcs@health.state.ny.us Revised: March 2010 Department of Health Provider Inquiry Assistance Point of Origin for Admission or Visit Codes Update to the UB-04 (CMS-1450) Manual Code List JA6801. Without remarks on the claim, the claim will be RTPd. This manual, copyrighted by the American Hospital Association, is the only official source of UB Data. %PDF-1.6 % Before you can enter the Noridian Medicare site, please read and accept an agreement to abide by the copyright rules regarding the information you find within this site. As in the auto accident example above, a victim brought to the ER would be coded as 7 since the patient was not previously at any other kind of health care facility. What code replaces it? ADA DISCLAIMER OF WARRANTIES AND LIABILITIES. Submit HCPCS modifier Q1 only on line items related to the clinical trial diagnosis code V70.7 (examination of participant in clinical trial) as the secondary diagnosis and condition code 30. CMS MLN Matters article MM6801, "Point of Origin for Admission or Visit Codes Update to the UB-04 (CMS-1450) Manual Code List". If no payment was made by the primary payer, or the claim was initially processed as a Medicare Secondary Payer code and being adjusted to reflect additional MSP information, use a D9 condition code. If the beneficiary was not an MA enrollee upon admission but enrolls before discharge, the MA organization is not responsible for payment. This information is updated weekly. Before sharing sensitive information, make sure youre on a federal government site. on the guidance repository, except to establish historical facts. Specifications Manual for Joint Commission National Quality Core Measures (2010A1), All Records , (used in algorithm for AMI-1, AMI-6, AMI-7, AMI-7a, AMI-8, AMI-8a, AMI-9, PN-1, PN-3a, PN-5, PN-5b, PN-5c, PN-6, PN-6a, PN-6b. 0000090455 00000 n An official website of the United States government. National Uniform Billing Committee (NUBC) Point of Origin Code Updates, This instruction provides point of origin code updates, Issued by: Centers for Medicare & Medicaid Services (CMS). These codes must be used to complete Display the claim that needs to be adjusted, press the 'F8' key to move to Page 2 of the claim, then press the 'F2' key. trailer The Department may not cite, use, or rely on any guidance that is not posted I am a provider and my Remittance Advice (RA) indicates a 935 withholding. 0000147084 00000 n This article explains the addition of two new valid point of origin codes to the valid No fee schedules, basic unit, relative values or related listings are included in CPT. We had an outpatient therapy claim deny with reason code U5390 overlapping with a home health agency. 0000002154 00000 n incorporated into a contract. CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. CDT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. The ADA does not directly or indirectly practice medicine or dispense dental services. Inpatient/Outpatient. If the adjustment cannot be completed in FISS (e.g., the claim is past timely filing and you need to correct the patient status so another provider can bill), submit a hard-copy adjustment using the, The services from admission through discharge, Occurrence Span Code M1 and dates of service, Non-covered charges for all services rendered. The beneficiary is not charged with utilization of benefit days, and the provider may not collect deductible and/or coinsurance. This Agreement will terminate upon notice if you violate its terms. The ADA is a third party beneficiary to this Agreement. When are uncorrected returns to provider (RTP) claims purged from the Fiscal Intermediary Shared System (FISS)? 0000001732 00000 n hbbd```b``vs@$b"2@$D4Xe#\$-L` X0 6 0000124451 00000 n No fee schedules, basic unit, relative values or related listings are included in CDT. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material. Includes information on the background of the NUBC, administration of NUBC meetings, methodology for request for changes and more. Please note that the 180 day count begins on the last date of access to the claim in RTP under Claims Correction in FISS Direct Data Entry (DDE). . xref 0000006342 00000 n CPT is a trademark of the AMA. PDF Medicare Claims Processing Manual Crosswalk - Centers for Medicare This product includes CPT which is commercial technical data and/or computer databases and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. 1. A federal government website managed by the Point of Origin Codes - JF Part A - Noridian For dates of service January 1 through June 30, 2012, OC 42 is only required in the following situations: For dates of service on and after July 1, 2012, OC 42 is only required when the patient revokes his or her hospice election. You, your employees and agents are authorized to use CPT only as contained in the following authorized materials including but not limited to CGS fee schedules, general communications, Medicare Bulletin, and related materials internally within your organization within the United States for the sole use by yourself, employees, and agents. 0000002077 00000 n Provider Inquiry Assistance Point of Origin for Admission or Visit Codes Update to the UB-04 (CMS-1450) Manual Code List - JA6801 . The new codes are E, Transfer from Ambulatory Point of Origin for Admission or Visit code 1"s, Chapter 25 example and definition has been updated. End users do not act for or on behalf of the CMS. Since the patient is seen by a different hospitals emergency room personnel, the decision to transfer the patient is first made by the other facility. 0000078514 00000 n FL15 Point of Origin for Admission or Visit 1 AN 1 2 FL16 Discharge Hour 1 AN 2 1 FL17 Patient Discharge Status 1 AN 2 1 . Can there be a post of processing issues on the CGS website? CMS DISCLAIMER. Change made in patient status PRIOR to discharge or release. New Point of Origin Code for Transfer from a Designated Disaster Alternate Care Site MLN Matters Number: MM11836 Revised . CDT is a trademark of the ADA. Physician concurrence with utilization review committee is documented in the medical records. The Department may not cite, use, or rely on any guidance that is not posted End Users do not act for or on behalf of the CMS. Please click here to see all U.S. Government Rights Provisions. If the patient was simply transported by law enforcement to our facility, the patient is neither under arrest nor serving any jail time, then the Point of Origin code would be 7 Emergency Room. This section contains Medicare requirements for use of codes maintained by the NUBC that are needed in completion of the Form CMS-1450 and compliant Accredited Standards Committee (ASC) X12 837 institutional claims. The Point of Origin code would be 5 as the original Point of Origin is the skilled nursing facility. SUMMARY OF CHANGES: This Change Request implements a new Point of Origin (PoO) Code "G" You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials. No fee schedules, basic unit, relative values or related listings are included in CDT. License to use CDT for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611. Premature delivery A baby delivered with time and/or weight factors qualifying it for premature status. Point of Origin. (eff. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights included in the materials. Toll Free Call Center: 1-877-696-6775. If the decision to admit was not made by the other facilitys emergency room personnel and instead was made by our facilities emergency room doctor, the Point of Origin code would still be 4. IF YOU ARE ACTING ON BEHALF OF AN ORGANIZATION, YOU REPRESENT THAT YOU ARE AUTHORIZED TO ACT ON BEHALF OF SUCH ORGANIZATION AND THAT YOUR ACCEPTANCE OF THE TERMS OF THESE AGREEMENTS CREATES A LEGALLY ENFORCEABLE OBLIGATION OF THE ORGANIZATION. If this is a U.S. Government information system, CMS maintains ownership and responsibility for its computer systems. The scope of this license is determined by the ADA, the copyright holder. SAS Name SRC_IP_ADMSN_CD The code indicating the source of the beneficiary's admission to an Inpatient facility or, for newborn admission, the type of delivery. Any questions pertaining to the license or use of the CDT-4 should be addressed to the ADA. CPT is a trademark of the AMA. ), 26 Century Blvd Ste ST610, Nashville, TN 37214-3685. What does this code mean? You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. Where can providers find additional information regarding the RAC process? 0000123643 00000 n For outpatient clinical trial claims: Yes currently, up to 5,000 RTP claims can be seen. In addition, each occurrence of C9399 should be billed with a corresponding unit of one, regardless of the actual quantity of the drug that is administered. This will allow providers time to submit an appeal or send in a check to CGS. 5. DISCLAIMER: The contents of this database lack the force and effect of law, except as Sick baby A baby delivered with medical complications, other than those relating to premature status. Pub 100-20 One-Time Notification Centers for Medicare & Medicaid Services (CMS) Transmittal 10178 Date: June 12, 2020 Change Request 11836. Get answers to your questions about the UB-04 manual including content, ordering, delivery, installation, printing and access. Access the Official UB-04 Data File containing the complete set of codes. The emergency room code is limited to patients who receive unscheduled emergency services in the ER not originating from another health care facility. You, your employees and agents are authorized to use CPT only as contained in the following authorized materials: Local Coverage Determinations (LCDs), training material, publications, and Medicare guidelines, internally within your organization within the United States for the sole use by yourself, employees and agents. CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. U.S. GOVERNMENT RIGHTS. Engage in the development of operating rules for the HIPAA transaction by becoming members of CORE. Subject to the terms and conditions contained in this Agreement, you, your employees and agents are authorized to use CDT only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. 0000026927 00000 n 0000026732 00000 n Form CMS-1450 Data Set, described in the Medicare Claims Processing Manual, If you do not agree to the terms and conditions, you may not access or use the software. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CDT. We are in the process of retroactively making some documents accessible. Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. The AMA is a third party beneficiary to this license. The code that best describes the origin of the patient's admission to the hospital. If billing multiple lines, each line should IF YOU DO NOT AGREE WITH ALL TERMS AND CONDITIONS SET FORTH HEREIN, CLICK ABOVE ON THE LINK LABELED "I Do Not Accept" AND EXIT FROM THIS COMPUTER SCREEN. One of these remarks must be included: BE, CD, DA, DP, FG, NB, PC, PE, or PP. Last updated April 21, 2023. THE LICENSES GRANTED HEREIN ARE EXPRESSLY CONDITIONED UPON YOUR ACCEPTANCE OF ALL TERMS AND CONDITIONS CONTAINED IN THESE AGREEMENTS. AMA warrants that due to the nature of CPT, it does not manipulate or process dates, therefore there is no Year 2000 issue with CPT. 135 0 obj <>stream Please. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. The .gov means its official. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer databases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (November 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements. CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. 0000079109 00000 n Type of Bill Frequency Code Excerpts for 837p and 837d. 0000124218 00000 n Transfer from hospital (Different Facility) The patient was admitted to this facility as a hospital transfer from an acute care facility where he or she was an inpatient. For the ANSI ASC X12N 837 I, hospital outpatient departments will report on type of bill (TOB) = 13x, containing revenue code 0636, HCPCS code C9399, and NDC number present in Loop 2400 LIN 03 of the 837 I, The hospital may report in the 'Remarks' section of the CMS-1450 or its electronic equivalent the National Drug Code (NDC) for the drug, the quantity of the drug that was administered, the unit of measure applicable to the drug or biological, and the date the drug was furnished to the beneficiary. End User/Point and Click Agreement: CPT codes, descriptions and other data only are copyright 2009 American Medical Association (AMA). Representatives have copies of letters that were sent to the provider and should be able to explain the withholdings. DISCLAIMER: The contents of this database lack the force and effect of law, except as 0 3. Subject to the terms and conditions contained in this Agreement, you, your employees, and agents are authorized to use CDT only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. These rejections usually appear on the claim when the line item dates of service (LIDOS) are within the admission and discharge dates of another facility's claim. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL COVERED BY THIS LICENSE. Should the for egoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by clicking below on the button labeled "accept". If the foregoing terms and conditions are acceptable to you, please indicate your agreement by clicking below on the button labeled "I ACCEPT". Welcome to the Website of the National Uniform Billing Committee, Noncommercial use of original content on www.aha.org is granted to AHA Institutional Members, their employees and State, Regional and Metro Hospital Associations unless otherwise indicated. Toll Free Call Center: 1-877-696-6775. This code has been discontinued. Providers are currently beginning the recovery audit contractor (RAC) process. 0 End users do not act for or on behalf of the CMS. An official website of the United States government. Transfer from Another Home Health Agency The patient was admitted to this home health agency as a transfer from another home health agency.

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