CMS Releases Updated Information about PECOS

Are your ordering/referring  physicians enrolled in PECOS?

On June 20th CMS released a revised MLN Matters article with updated information regarding PECOS and Phase 2 of the Ordering/Referring Physician Requirements.

During Phase 2, Medicare will deny Part A HHA claims that fail the ordering/referring provider edits. CMS has not announced a date when the edits for Phase 2 will become active. CMS will give the provider community at least 60 days notice prior to turning on these edits. Physicians and others who are eligible to order and refer items or services need to establish their Medicare enrollment record (PECOS).

It is possible that it could take 45-60 days, sometimes longer, for Medicare enrollment contractors to process enrollment applications. All enrollment applications, including those submitted over the web, require verification of the information reported. Sometimes, Medicare enrollment contractors may request additional information in order to process the enrollment application.

Waiting too late to begin this process could mean that physicians’ enrollment applications will not be able to be processed prior to the implementation date of Phase 2 of the ordering/referring provider edits. In Phase 2, if the Ordering/Referring Provider does not pass the edits, the claim will be denied.This means that the billing provider will not be paid for the items or services that were furnished based on the order or referral. For more information Click Here

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New Code to Report Date of Death on Medicare Claims

October is months away but be prepared…Effective Oct.1, 2012 Medicare-certified agencies will use occurrence code 55 to indicate a date of death on claims.

The new occurrence code will be used in conjunction with all discharge status codes indicating the patient has expired – 20 (expired), 40 (expired at home), 41 (expired in a medical facility), or 42 (expired – place unknown)

Please note that hospices are not to use discharge status code 20 per Section 30.3 of Chapter 11 of the Medicare Claims Processing Manual. Additional information on the use of code 55 can be found in the MLN Matters and in the Change Request (CR) 7792

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Post Acute Patterns and Reform Possibilities Discussed at Annual Meeting

How and how much Medicare pays for post acute care and where there is room for reform was the subject of the featured presentation at the Alliance’s annual meeting by Al Dobson of the Washington think tank Dobson/DaVanzo.  The analysis was part of  the Clinically Appropriate and Cost‐Effective Placement (CACEP) Project, which D/D has been engaged in on behalf of the Alliance for Home Health Quality and Innovation (AHHQI).  According to Dobson, the data present a powerful case for rethinking the role of home health not only for patients leaving hospitals, but for deterring hospitalizations for patients residing in communities.    “The home health community has recognized that it is more cost‐effective than facility‐based settings,” said Dobson,  “but until now, has lacked the data analyses to support anecdotal evidence.”

One of the study’s findings is that of those patients referred for some form of post acute care, 38% are referred for home care; but these patients represent less than 30% of post acute payments.  Dobson also presented data on the range of patient pathways following an acute stay suggesting that globally paid providers and bundled demonstrations are going to take a hard look at these with an eye toward both costs and outcomes and with a goal of  simplification.

The CACEP study has now produced three working papers, all of which are on the AHHQI website,  free of charge.

Dual Eligible Services Demo RFR Now Available

The state’s Executive Office of Health and Human Services (EOHHS) has released the Request for Responses relative to the demonstration project to integrate care for dually eligible individuals.

The RFR is a solicitation for potential Integrated Care Organizations, or ICO’s, that will manage the integration of services and payment for dual eligibles aged 21-64. The Home Care Alliance is holding a special event for all agencies interested in this initiative. Please see the event in our Calendar section titled “Building Partnerships with Managed Care Plans for Dual Eligible Care” where special guest speakers will educate attendees on the demonstration and how agencies can play a key role. Potential ICO’s have also been invited for discussion and networking.

For those interested in viewing the  solicitation and corresponding materials, the instructions are below:

1)  In your browser, enter the URL for the Commonwealth’s procurement web page: www.comm-pass.com.

2)  Near the bottom of the page, click on the hyperlink that reads: “Search for Solicitations.”

3)  When the Search page comes up, scroll down to the section that says “Search by Specific Criteria” and in the document number box, enter the following: 12CBEHSDUALSICORFR.

4)  The Search result will appear as a hyperlink at the top of the new page. It should read: “There is 1 solicitation(s) found that match your search criteria.”  Click on this sentence and it will take you to the Comm-PASS listing for this solicitation.

5)  Click on “view” (the eyeglasses on the right) and you will get the summary page for the Request for Responses for Integrated Care Organizations.

6)   Click on the blue folder-type tab called “Specifications” and you will see the RFR documents and appendices that have been posted for this topic. In addition, the required forms that Respondents to the RFR will need to provide are available under the “Forms and Terms” tab.  To view the documents, click on the eyeglasses to the right of the title of each document,  .

The documents will also be posted shortly on our duals demonstration website, www.mass.gov/masshealth/duals, under “Information for Organizations Interested in Serving as ICOs.”

Responses to the RFR will be due to MassHealth by 4:00 PM (EDT), July 30, 2012.

Return to www.thinkhomecare.org.

2012 Annual Report: This We Know For Sure

The Alliance’s 2012 Annual report This We Know For Sure is now available for digital download from our website.  Learn  about both the Alliance’s vision for the future, and help us celebrate this past year’s successes, including:
  • Sponsorship of our  first Innovation Showcase;
  • The re-launch of our Job Bank as the New England Home Health Career Center;
  • Work on Wage and Hour Issues, especially those related to overtime and live-in care;
  • Development of new programs through the Foundation for Home Health, including an interactive video presentation on the “Art of the Home Care Admission Visit,” as well as trainings for ICD-9-CM coding and OASIS–C.
  • Sponsorship of a Western Mass RWJ grant on developing a care transitions curriculum for nurses.
  • Assistance in navigating changes to the CORI process and new parameters around free access for agencies with state contracts;
  • Expansion of the Boston Parking Placard Program;
  • Redesign of the Resource Directory and “Find an Agency” web search;
  • Revamp of the Agency Accreditation Program
  • Leadership on proposals to reject efforts to impose a co-payment on Medicare home health;
  • Negotiation a significant change in state Medicaid policy in delaying any TPL recoupments;
  • Plans to revise and dovetail the Home Health Universal Authorization Form;
  • Sponsorship of Lobby Day to bring members together with legislators to advance telehealth, changes to nurse delegation practices and a state certificate of need process; and
  • Assembled and distributed a series of “Keeping It Legal” policy statements on Patient Choice, Illegal Inducements and the Medicare Face  to Face Rules;

…and others!  Download the PDF today to find out more.

State Budget Advocacy Needed on Telehealth

The FY13 state budget conference committee that will meld the House and Senate budget proposals are in negotiations and HCA needs your help in advocating so that we can achieve MassHealth reimbursement of telehealth services and adequate funding in the state home care programs.  (According to Mass Home Care, there were 935 elders on the Enhanced Community Options program waiting list as of May, 2012.)

Members and advocates can do their part by calling or emailing the members of the conference committee and asking them to:

  1. Support Senate budget amendment #692 which would direct Masshealth to reimburse for telehealth services
  2. Support the House funding proposal over the Senate’s for Enhanced Community Options Program (ECOP), line-item 9110-1500.  The House budget proposal gives the ECOP program $1.327 million more than the Senate.
  3. Support House funding proposal over the Senate’s for Elder Home Care Purchased Services, line-item 9110-1630.  The House budget gives almost $500,000 more dollars to this account which funds the Basic Elder Home Care program.

Here are the names, email addresses and phone numbers of the conference committee:

The telehealth amendment language, data, and talking points are all available on a fact sheet prepared by the Alliance.  Please contact these legislators today, even if they do not represent your area.  Please urge your legislators to do all he/she can to support this funding. In addition, when you speak to your Senator’s office, be sure to thank the Senate for adding this critical funding to their FY13 budget proposal.

If you or the legislators you speak with have any questions, contact James Fuccione at HCA.

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HCA Updates “Regulatory Center” on Website

Get confused by all the home health care regulations? Have trouble finding the exact regulation you are searching for? Want to find one handy location with all the regulatory links?

Visit the “Regulatory Center” page on thinkhomecare.org  for convenient links to home health care’s federal and state regulations.  You will also find home care related links to Medicare, MassHealth, Managed Care and the Executive Office of Elder Affairs.

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Hospice Quality Reporting Program Update

Hospices will be mandated-for the first time-to collect data on specific quality measures during the final calendar quarter of 2012 as part of the Hospice Quality Reporting Program. Failure by a hospice to submit the required data will result in a 2 percent reduction to that hospice’s payments during fiscal year 2014

In the June 4, 2012 Federal Register there is a notice regarding the data submission form to be used for reporting the required quality data. The Hospice Quality Reporting Program submission forms is now available, once you download the form click on “Hospice Mandatory Data Submission Form”.

For additional information about the Hospice Quality Reporting Program Click Here

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HCA Achieves Gains for Home Care in House Health Care Bill

With the passage of a major health care payment reform bill by both the state’s senate and house of representatives, the Alliance will advocate for the successes gained in each version as the proposals advance.

In the recently passed House version, the Alliance was successful in advocating that home health and hospice services are included in the definition of “health care services” under an Accountable Care Organization able to accept global payments.

Other provisions achieved, include:

  • An amendment to strengthen the relationship between Patient-Centered Medical Homes and federally-certified home care agencies by ensuring that those agencies are available through the medical home to provide “after-hours” availability to home care patients.
  • An amendment that  improves the state’s “fair share contribution” calculation for determining an employer’s percentage of insured workers. With this amendment, any employee insured through a spouse, parent, Medicare/Medicaid, a veterans’ plan or disability plan would NOT be counted towards the employer’s test by the state and thus reduces the chance the employer would have to pay the “fair share contribution” penalty ($295 per employee).
  • An amendment adding “a community-based organization or group of community-based organizations” to those entities available to receive funding from the Prevention and Wellness Trust Fund.
  • An amendment ensuring that community-based behavioral health providers are included in the state’s health information technology planning process and that providers who serve high proportions of public payer clients will be given priority in receiving funding through a “health information technology revolving loan fund.”

The Alliance will continue to advocate for these provisions, in addition to those gained in the Senate, which can be seen in our blog post on the Senate’s passage of their payment reform bill.

Return to www.thinkhomecare.org.

 

IHI Releases “How-to-Guide” for Home Health/Community Settings

This week the Institute for HealthCare Improvement (IHI) posted on their website, The How-to Guide: Improving Transitions from the Hospital to Post-Acute Care Settings to Reduce Avoidable Re-hospitalizations. This How-to-Guide is designed to support hospital-based teams and their community partners to co-design and reliably implement improved care processes to ensure that patients who have been discharged from the hospital have an ideal transition to home or to the next community care setting. The Home Care Alliance is acknowledged as a contributor and editor of this document.

Return to www.thinkhomecare.org.