I do commercial billing for a home health agency. We use S9123, "nursing care, in the home, by registered nurse, per hour" for each skilled nursing visit, specifically for billing United Healthcare. The problem is that the claims are auto generated and sometimes they will have multiple units for one visit (eg. S9123 – 3 units) on 9/18/17, etc. I don’t know why the extra units are being generated because when I check clinical notes, our direct time with the patient was only about an hour, not three hours.

So my question is, is this a problem that needs to be fixed? The payer is still paying us for one unit per line item billed so it’s not like we are overbilling and being overpaid. The issue happens when we are only authorized for 20 visits for one period of time, and the payer takes off all the visits due to the number of units being billed. Then I have to send a corrected claim with only one unit per day.

Does anyone know if we definitely should be billing one unit per hour and our system is generating the claims incorrectly? My manager says the units shouldn’t matter but it’s causing problems with the authorizations. I’ve tried searching on Google but I can’t find anything helpful.

Thanks!