National Provider Call: Activation of PECOS Edit May 1

Register for the National Provider Call on Wednesday, March 20; 3-4pm

CMS will hold a national provider call on March 20 from 3-4pm ET on the “Implementation of Phase 2 Edits on the Ordering/Referring Providers in Medicare Part B and Part A -Home Health Agency Claims.”

Effective May 1, 2013, CMS will instruct contractors to turn on Phase 2 denial edits; checking Medicare claims for home health services ordered by physicians who are not enrolled in the Medicare Provider Enrollment, Chain, and Ownership System (PECOS). If physicians are not enrolled these claims will be denied.

In order to receive call-in information, you must register  on the CMS website CMS Upcoming National Provider Calls. During the registration process, advanced questions may be posted

National Provider Call Agenda:

  • Provider Types Eligible to Order/Refer
  • Action Steps for Billing Providers
  • Action Steps for  Providers Who Order/Refer
  • Resources

Return to www.thinkhomecare.org.

HCA Executive Director Named to Key Health Policy Advisory Group

Home Care Alliance Executive Director Patricia Kelleher has been named to the Health Policy Commission Advisory Council joining a list of other health care leaders  who will help guide the implementation of the state’s Health Care Cost Containment Law.

Better known as Chapter 224, (“An Act Improving the Quality of Health Care and Reducing Costs through Increased Transparency, Efficiency and Innovation”) the law requires the Health Policy Commission’s (HPC) Executive Director to establish the Advisory Council and designate members with diverse perspectives on the health care system to two-year terms. The Council will advance Chapter 224 implementation by advising on the HPC’s overall operations and policies, providing feedback on a grant program to support new system delivery and payment reform methods, and encouraging public and stakeholder engagement in the HPC’s work.

“This is an impressive group that promises to enrich the HPC’s work,” said Executive Director Seltz. “They are part of the coalition that made the first chapter of Massachusetts health care reform such a resounding success and the passage of our nation-leading cost containment law possible. Each member will bring a different and important perspective to our work to implement Chapter 224. I am grateful for their willingness to serve.”

The Advisory Council includes the following members from across the state:

  • Christine Alessandro, Executive Director, BayPath Elder Services, Inc.
  • Dianne Anderson, RN, President & CEO, Lawrence General Hospital
  • Michael Caljouw, Vice President, Government & Regulatory Affairs, Blue Cross Blue Shield of Massachusetts
  • JD Chesloff, Executive Director, Massachusetts Business Roundtable
  • Cheryl Clark, MD, Director of Health Equity Research & Intervention, Brigham & Women’s Hospital
  • John Cox, President, Cape Cod Community College
  • Karen Day, Executive Director, US Policy, AstraZeneca
  • Ralph de la Torre, President & CEO, Steward Health Care System
  • Vicker “Vic” Digravio, President & CEO, Association of Behavioral Health
  • Ronald Dunlap, MD, South Shore Hospital, President-Elect, Massachusetts Medical Society
  • John Erwin, Executive Director, Conference of Boston Teaching Hospitals
  • Julian Harris, MD, Director, Office of Medicaid
  • Jim Hunt, President & CEO, Massachusetts League of Community Health Centers
  • Jon Hurst, President, Retailers Association of Massachusetts
  • Dan Keenan, Senior Vice President, Government Relations, Sisters of Providence Health System
  • Patricia Kelleher, Executive Director, Home Care Alliance of Massachusetts
  • Gene Lindsey, MD, President & CEO, Atrius Health
  • Geoff MacKay, President & CEO, Organogenesis
  • David Martin, Senior Director, Health Policy, Covidien
  • David Matteodo, Executive Director, Massachusetts Association of Behavioral Health Systems, Inc.
  • Dolores Mitchell, Executive Director, Group Insurance Commission
  • Abraham “Ned” Morse, President, Massachusetts Senior Care Association
  • Joyce Murphy, Executive Vice Chancellor, Commonwealth Medicine, University of Massachusetts Medical School
  • Lynn Nicholas, President & CEO, Massachusetts Hospital Association
  • Cheryl Pascucci, APRN, FNP-C, Commonwealth Care Alliance
  • Lora Pellegrini, President & CEO, Massachusetts Association of Health Plans
  • Julie Pinkham, Executive Director, Massachusetts Nurses Association
  • Donald Thieme, Executive Director, Massachusetts Council of Community Hospitals
  • David Torchiana, MD, President & CEO, Massachusetts General Physicians Organization
  • Celia Wcislo, Vice President, 1199 SEIU of Massachusetts
  • Brian Wheelan, Executive Vice President for Corporate Strategy & Development, Beacon Health Strategies
  • Amy Whitcomb Slemmer, Executive Director, Health Care for All

Return to www.thinkhomecare.org.

Best Around the (Home Care) Web II

Each week, the Alliance scours the blogospherefor the news affecting the home care industry.  Here are highlights from this week:

Not All Procedures Are Created Equal: Top Five to Avoid

The Choosing Wisely campaign, an initiative by the American Board of Internal Medicine Foundation in partnership with Consumer Reports… is an attempt to alert both doctors and patients to problematic and commonly overused medical tests, procedures and treatments.

It took an elegantly simple approach: By working through professional organizations representing medical specialties, Choosing Wisely asked doctors to identify “Five Things Physicians and Patients Should Question.”

The idea was that doctors and their patients could agree on tests and treatments that are supported by evidence, that don’t duplicate what others do, that are “truly necessary” and “free from harm” — and avoid the rest.

Among the 18 new lists released last week are recommendations from geriatricians and palliative care specialists, which may be of particular interest to New Old Age readers. I’ve previously written about a number of these warnings, but it’s helpful to have them in single, strongly worded documents. — via, NYT New Old Age Blog

Are Video Games Therapeutic? Wii Think So!

Researchers asked 140 people aged 63 and older how often they played video games, if at all. The study participants then took a battery of tests to assess their emotional and social well-being. 61 percent of study participants played video games at least occasionally, with 35 percent of participants saying they played at least once per week.

The study found that participants who played video games, including those who only played occasionally, reported higher levels of well-being. Those who did not play video games reported more negative emotions and a tendency toward higher levels of depression. — via Medical News Today; original paper available for purchase here.

Skype Care: Families Prefer Check-ins By Video

For the study, 34 families were broken up into three groups: one receiving standard [pediatric] home healthcare, a web group receiving home healthcare supplemented with a web app; and a video group with home healthcare supplemented by Skype. Participating families and nursing staff completed questionnaires about the information and communication technology’s (ICT) usefulness.

The web application was easy to use, participants said, and Skype was useful for all surveyed, too. Nearly 90 percent said that video calls were better than regular phone calls. Meanwhile, 33 percent in the web group and 75 percent in the video group thought that home visits should be less frequent with the advent of Skype. Fifty percent in the web group and 100 percent in the video group said they felt more confident in caring for their child after using the technology. — via HCAF

Making Home Gardens Accessible For Seniors

It is now our turn as caregivers to share new, accessible gardens and the fulfillment of getting our hands dirty again with our senior loved ones as they age. Many seniors find that the effects of aging on joints, muscles and the freedom of movement have prohibited them from tending to their beloved gardens — via Senior Care Corner (includes a how-to video on making senior-friendly vertical planters).

Return to www.thinkhomecare.org.

Are You Prepared for the May1st PECOS Edit?

Effective May 1st, CMS will deny home health claims where the physician on the claim does not have an enrollment record in the Provider Enrollment, Chain and Ownership System (PECOS).

CMS released MLN Matters-SE1305, on March 1st, detailing information regarding this new “phase 2” edit.  Phase 2 is part of CMS’s implementation of Section 6450 of the Affordable Care Act, which requires physicians or other eligible professionals to be enrolled in the Medicare Program to order or refer items or services for Medicare beneficiaries, even if those physicians do not directly bill Medicare for any services.

Home Health claims will be denied with one of two reason codes, according to the March 1st MLN Matters article:

  • 37236: The statement “from” date is on or after May 1, the type of bill is “32” or “33” and the attending physician’s national provider identifier (NPI) is not present in PECOS. The claim could also be denied if the NPI is present in PECOS but the name given on the claim doesn’t match the one on the physician’s enrollment record.
  • 37237: Same as above, but this denial reason code will be assigned only when the type of bill frequency code is “7,” which indicates an adjustment, or “F-P.”

Check your referring physicians’ status in PECOS; agencies may be forced to hold billing the claim for physicians who are not enrolled.

Return to www.thinkhomecare.org.

CMS Releases Updated Q&As for F2F and Therapy

On February 28th, CMS released updated Q&As for the F2F Encounter and Therapy Reassessment requirements on the Home Health Center Web Site.

The revised F2F Encounter Q&As are essentially the same with clarification that the agency may title and date the encounter form if the physician fails to date his/her signature. (Question 17; page 6-7)

The revised Therapy Q & As provide several examples of when therapy visits would be non-covered, when the reassessment visit is missed, and clarifying when assessments are due in relation to “at least every 30 days”  according to the revised regulation effective Jan 1, 2013,

Return to www.thinkhomecare.org.

Guest Post: Your Legislators Need to Hear From You

By: Beverly Pavasaris
President, Brockton Visiting Nurse Association
President, Home Care Alliance Board of Directors

MA-State-HouseWith six home care-related bills working their way through the State House and budget meetings in progress, now is an ideal time to get to know your legislators and speak with them about the importance of home health in their districts.

Here are four things you can do to make a difference:

Talk to your Representatives

State representative and senators (find them here) rely on informed constituents to help them understand the legislation before them.  Don’t assume that they know what home health care is or why it’s important. Be prepared to educate your legislators or their health care staff. It is well worth your time.

Your congressmen and senators, also have district offices near you, whose staff you can speak with. Make it a point to reach out to them when they are in their home district offices.

Before you contact your legislators, be sure to read up about the home care-related bills proposed in this session (and which the Home Care Alliance endorsed):

  • An Act Relative to Home Health and Hospice Aides (S.1064) sponsored by Senator Richard T. Moore.
  • An Act Establishing a Certificate of Need for Home Health Care (H.1028) sponsored by Rep. Kate Hogan
  • An Act Allowing Out of State Physicians to Order Home Care Services (S.1042) sponsored by Senator Michael Knapik
  • An Act Relative to Telehealth (Senate Docket 1771) sponsored by Senator Harriette Chandler
  • An Act Relative to Pediatric Home Care Services (H.1007) sponsored by Rep. Michael Brady
  • An Act Relative to Vehicles of Home Health Clinicians (H.1864) sponsored by Rep. John Mahoney

Be sure to contact both your personal representatives – i.e., those who represent the district you live in – and those who represent the district where your business is located.

Schedule a Home Visit

Invite legislators – both state and federal – to come with you on a home visit. Seeing how home care works is more powerful than hearing description over the phone, and also gives them a chance to meet with constituents and get a good photo op.  If you would like assistance in setting up a visit, contact the Alliance’s James Fuccione.

Recruit Your Board & Employees

Your board members and employees can also be powerful advocates for home care. Inform them about the issues and have them make phone calls to their representatives as well.

Attend Lobbying Events

  • March 17th through the 20th is NAHC’s March on Washington;
  • Massachusetts Lobby Day at the State House on March 28th; and
  • VNAA Public Policy Leadership Conference is on September 18-19, 2013 in Washington.

If you have any questions about contacting your legislators, contact James Fuccione, the Alliance’s Director of Legislative and Public Affairs.

Good luck and see you at the State House and in Washington!

Return to www.thinkhomecare.org.

Best Around the (Home Care) Web

As a new feature, the Alliance will scour the blogosphere each week for the news affecting the home care industry.  Here are highlights from this week:

Prevent Falls with a Nightlight

Are you looking for a device that can help your loved one lower his or her risk of falling in the home? How about one that fits in the palm of your hand? Surprisingly this post isn’t about the latest generation of smart phones, but the good old-fashioned nightlight.  — VNSNY

CDC: Most Recent Flu Vaccine Ineffective For Seniors

This season’s flu vaccine was almost completely ineffective in people 65 and older, which could explain why rates of hospitalization and death have been some of the highest ever recorded for that age group, according to early estimates released Thursday by the Centers for Disease Control and Prevention.

For people under 65, getting vaccinated this season reduced the need to go to the doctor for the flu by one-half to two-thirds.   — USA Today, via CommonHealthBlog

Talking to Seniors About ID Theft & Financial Security

Identity theft may never happen to one of your senior loved ones – – and we hope it does not. It’s so much easier to take protective steps up front than it is to repair the mess it can become afterward, however, that we should help the seniors in our lives consider and implement those steps. — via Senior Care Corner

Report: Alzheimer’s Cases Could Triple By 2050

Doctors, researchers and public health experts are already bracing for an onslaught of new patients by developing drugs and preparing caregivers for the emotional and physical stress.

“This is an issue that’s going to touch each of us personally or someone that we know and care about,” said Lora Connolly, director of the California Department of Aging, which expects to be serving as many as 1.2 million patients with Alzheimer’s or dementia in the state by 2030. “It won’t happen overnight, but the pressure will continue to mount.” — LA Times, via CommonHealth

Return to www.thinkhomecare.org.

Caregiver Videos: Introduction to Physical Therapy

Earlier this year, we introduced the Care Giver Video Resource Center, our YouTube series for family care providers about home care and home care agencies.

In the seventh video in the series, Geoffrey Abraskin, PT, DPT of Amedisys Home Health & Hospice Care discusses what Physical Therapy is and how it can be used in a home care setting.

To view the full series, visit our YouTube channel.  To access library of hundreds of care giver resources on a variety of subjects, visit www.eldercareskills.org, who produced the videos with us. Continue reading “Caregiver Videos: Introduction to Physical Therapy”

Nominate Your Best Nurses for Boston Globe Honors and Annual HCA Event

The Boston Globe will be running a special section called the “Salute to Nurses,” which will be a standalone broadsheet section appearing in The Boston Sunday Globe on May 5, 2013. This section will focus on the stories that readers submit, recognizing the impact nurses have on patients’ lives.

Over the past 11 years, thousands of people have found “Salute to Nurses” to be a meaningful and public place to give thanks to the nurses who have helped them or loved ones through difficult times.

Visit the Boston Globe’s online form and submit your best nurse stories and, for agencies, encourage your patients to do the same if they have had a exceptional experience. This is an excellent opportunity to shine a light on the work of home health nurses.

Another opportunity to spotlight the great work from nurses, aides, and other staff is to nominate them for a “Star Award,” which will be given out at HCA’s annual Innovations Showcase and Star Awards Ceremony on April 17th at the Revere Hotel in Boston.

See the posting on the Alliance’s Calendar of Events for more details.

Return to www.thinkhomecare.org.

Guest Post: Time for Nurse Delegation Bill to Pass

By: Beverly Pavasaris, President, Brockton VNA
President, Home Care Alliance of Massachusetts

Once again this legislative session, the Home Care Alliance of Massachusetts has filed a bill (An Act Relative to Home Health & Hospice Aides) to allow nurses working in home health agencies and hospices to delegate the administration of certain medications to home health aides. Before this would occur, the home health agencies would need to provide training, certify competency skills and  establish documentation protocols according to the nurse delegation model developed by the National Council of State Boards of Nursing. Such regulations, according to the bill, will be drafted by the state’s Board of Registration in Nursing in collaboration with the Massachusetts Department of Public Health and with nursing input.

In past legislative sessions, I have testified in support of this bill as a creative and progressive solution to removing existing barriers that obstruct home health patients from getting needed care. Our legislation recognizes the changing scope of work that can be safely provided by paraprofessionals with appropriate nurse oversight and helps prepare our state for the aging of our population and growth in clients living at home with medical condition that are stable and predictable.

If this bill were to pass we would by no means be in the forefront of this issue.  A number of states, including Oregon and Washington, and most recently Connecticut , have addressed at-home medication delegation, resolving that the need for assistance with managing and administering medications should not drive citizens into nursing homes. Aside from the improved efficiency of care, Connecticut anticipates a $28 million savings per year from their effort to allow certified home health aides to assist nurses with certain tasks.

An obstacle to getting this bill passed has been lack of support from the state’s professional nursing organization: MNA. The Alliance has met with them on numerous occasions and assured them that this bill is intended to keep nurses, who are uniquely qualified to promote the health of patients in their homes, closely involved in the administration of medication.  They remain unconvinced.

At this time, the Board of Registration in Nursing is looking at revising their own delegation regulations to prepare for possible delegation of medication administration in the home. But we need the Legislature to act, and we would like to show them that we have nursing support.

Please get involved.  If you belong to MNA, let them know you support this.   If you would like to testify or set up a legislative meeting on this issue, contact James Fuccione, jfuccione@thinkhomecare.org.

Return to www.thinkhomecare.org.