2013 Private Care Guides Available

The Alliance will begin shipping copies of its new 2013 Guide to Private Home Care Services next week.

The Guide is designed to educate clients and families about their private home care options and to help them choose from our 132 member agencies that accept private pay, including those who have completed our Agency Accreditation Program.  Contents include:

  • Introduction:
    • Understanding What Home Care Is;
    • Understanding the Agency Advantage (New!);
    • Assessing Your Needs;
    • Exploring Payment Options;
    • Knowing About Agency Accreditation;
    • Finding & Interviewing Agencies;
  • Agency Profiles of 132 Private Care Agencies
  • County-By-County Cross Reference

The Alliance will ship copies of the Guide to all members, as well as every hospital case management office, Aging Service Access Point (ASAP), Council on Aging (COA), Geriatric Care Manager (GCM), Veterans’ Center, and dozens of other referral sources. Additional copies are available for order on our website, as is a downloadable PDF versionGuides are always available free of charge with no shipping charges on copies of 50 or less.

Return to www.thinkhomecare.org.

CMS’ Open Door Forum-Encore recording

Did you miss CMS’ Open Door Forum (ODF) yesterday? You still have the ability to listen to the Encore recording by dialing 1-855-859-2056 and entering the Conference ID 72193272. The recording expires after 3 business days.

Agenda for ODF

I. Opening Remarks

II. Announcements & Updates

1. Open Enrollment Announcement

2. Flu Vaccination Announcement

3. Home Health PPS – Effective Date of Therapy Provisions

4. Incorrect Patient Status Codes on Hospice Claims


6. DMEPOS Competitive Bidding

7. Update to OASIS web-based training at: http://surveyortraining.cms.hhs.gov, addition of module, OASIS C Online Training: Patient Tracking Domain

lII. Open Q&A

 **Mark your calendars**Next ODF: Wednesday, January 9, 2013**

Return to www.thinkhomecare.org.

CMS Releases New MLN Article

On November 26th, CMS released the Medicare Learning Network  Article- (SE1237) Importance of Preparing/Maintaining Legible Medical Records. This article highlights the importance of legible documentation in avoiding claim denials. The key points highlighted:

  1. General Principles of Medical Record Documentation
  2. Medicare Signature requirements
  3. Amendments, Corrections and Delayed Entries

If you are looking for more facts on amendments, corrections and delayed entries see the Medicare Program Integrity Manual Section The MLN article, Complying with Medicare Signature Requirements, provides a question and answer format for information on signature regulations

Return to www.thinkhomecare.org.

OIG Report: ALJs Need Training

Not surprisingly to any agencies involved in the TPL project, a new report from the Office of Inspector General of the US Dept. of Health & Human Services found a range in inconsistencies and shortcomings in the Administrative Law Judge level of the Medicare appeal process.

A sampling of some of the findings of the study:

  • Two State Medicaid agencies [one of which clearly is Massachusetts] filed more than 500 appeals each in 2010.  Many ALJ staff raised concerns about these frequent filers, noting that some of these appellants appeal every payment denial, and pointing out that these appellants have an incentive to appeal because the cost is minimal and a favorable decision is likely
  • The fully favorable [ALJ coverage decision] rate varied substantially by appellant type. For providers, it was 61 percent. In contrast, the fully favorable rate was just 22 percent for State Medicaid agencies.
  • ALJs tended to interpret Medicare policies less strictly than QICs
  • The favorable rate varied widely by ALJ.  According to many ALJ staff, different philosophies among ALJs contribute to the variation in fully favorable rates. They said that given the same facts and the same applicable Medicare policy, some ALJs would make decisions that are favorable to appellants, while others would not.

The report’s recommendations to CMS and the Office of Medicare Hearings and Appeals include:

  • Develop and Provide Coordinated Training on Medicare Policies to
  • ALJs and QICs
  • Identify and Clarify Medicare Policies That Are Unclear and
  • Interpreted Differently
  • Standardize Case Files and Make Them Electronic
  • Revise Regulations To Provide More Guidance to ALJs Regarding
  • the Acceptance of New Evidence
  • Improve the Handling of Appeals From Appellants Who Are Also
  • Under Fraud Investigation and Seek Statutory Authority To Postpone
  • These Appeals When Necessary
  • Seek Statutory Authority To Establish a Filing Fee
  • Implement a Quality Assurance Process To Review ALJ Decisions
  • Determine Whether Specialization Among ALJs Would Improve Efficiency.

Return to www.thinkhomecare.org.

Hospice WebEx Training on Data Submission — Taken Offline

CMS put out notification last week that the WebEx training related to the Hospice Quality Reporting Program (HQRP) was available online.  It was available for a BRIEF time on Wednesday night and Thursday; the WebEx training is temporarily unavailable due to technical issues.  Only the Technical User Guide is available on the website. The contractor is working to correct the issues and will get the training and manual back up as quickly as possible.  The HCA will keep you updated.

Return to www.thinkhomecare.org.

Hospice Quality Reporting WebEx Now Available

Looking for more information about the new requirements for Hospice Quality Reporting?

The CMS WebEx training module on data submission for the Hospice Quality Reporting Program is now available online.  It will remain available until April 2013. The training will help hospices prepare for web-based data entry and submission of quality data affecting the FY 2014 reimbursement rates.

To meet the hospice quality reporting requirements in order to qualify for full payment of Medicare rates in FY 2014, hospices must submit two measures: the Structural/QAPI measure and the NQF #0209 measure. Reporting of the structural measure may begin Jan. 1, 2013, and must be completed by Jan. 31, 2013, while reporting of data on the pain measure (NQF 0209) must be completed by April 1, 2013.

For more information visit Spotlight and Announcements on the Hospice Quality Reporting website.

Boston Globe Letter on Home Health and Readmissions

The following was published in the Boston Globe on Sunday, November 11th:

To the Boston Globe:

A renewed attention on the part of the health care delivery system in general, and hospitals specifically, to keeping people who have been hospitalized from quickly returning is welcome and long overdue (“Hospitals look to lower readmission rates,” G section, Nov. 5). However, in focusing on some new programs and services, the story seemed to miss the solution with a long track record of success. For more than a century, home health care as delivered by visiting nurses and other professionals has been the most valuable and valid means to support patients and minimize complications following a stay in a hospital.

These nurses have knowledge about the patient’s health and what in the home environment may be an obstacle to a patient’s medical progress. Yet, our experience is that far fewer patients are referred for home health services than could benefit from them, generally because of a lack of understanding of qualifying rules for coverage.

As we broaden the post-acute-care safety net, it’s important to remember that visiting nurses, who heal and teach, are most successful at delivering what patients need to avoid a return hospital visit.

Patricia  Kelleher, Executive Director

Home Care Alliance of Massachusetts

Return to www.thinkhomcare.org.