Tag: CMS

Centers for Medicare & Medicaid Services

CMS Releases Hospice Item Set Draft

CMS recently published a  draft version of the Hospice Item Set (HIS) that hospice agencies will be required to collect for patients admitted on or after July 1, 2014.

The HIS has two versions: Admission and Discharge. The admission version needs to be completed within 30 days of admission and CMS estimates that it will take your hospice 19 minutes to gather and input all the information needed to complete. The discharge version of the HIS must be completed within 30 days of discharge and is estimated to take 10 minutes to complete the shorter discharge set.

Information CMS is proposing to collect includes numerous process measures, such as whether the patient was asked about preferences regarding CPR and other life-sustaining treatment, and whether the patient or caregiver was asked about spiritual or existential concerns.

If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.

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US HHS Releases Data on What Hospitals Charge

The federal office of Health and Human Services and Centers for Medicare and Medicaid Services (CMS) have released data on what hospitals across the nation charge for the 100 most common Medicare inpatient stays.  Hospitals determine what they will charge for items and services provided to patients and these “charges” are the amount the hospital generally bills for an item or service.

The variance in what hospitals charge both regionally and by procedure is apparent and is already the subject of a story in the New York Times.A press release by HHS highlights the fact that, even within the same geographic area, prices can vary dramatically. For example, the average inpatient hospital charges for services that may be provided to treat heart failure range from a low of $21,000 to a high of $46,000 in Denver, Colo., and from a low of $9,000 to a high of $51,000 in Jackson, Miss.

The Home Care Alliance isolated the state-specific data for Massachusetts here.

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CMS ODF- May 8th

The next Home Health, Hospice & DME Open Door Forum is scheduled for Wednesday, May 8, 2013 at 2:00 PM Eastern Time (ET).

Agenda:

Opening Remarks- Chair – Randy Throndset, Division Director, Division of Home Health, Hospice and HCPCS (CM)

Moderator – Matthew Brown (OC)

 Announcements & Updates:

  1. Health Insurance Marketplace Update
  2. HHCAHPS
  3. OASIS Modules
  4. Hospice Update
  5. Hospice Cost Report Update/PRA
  6. Claims Processing Update
  7. Re-Issued G-Code Reporting CR
  8.  Open Q&A

Open Door Participation Instructions:

This call will be Conference Call Only.

To participate by phone:

Dial: 1-800-837-1935 & Reference Conference ID: 78867258.

 Encore: 1-855-859-2056; Conference ID: 78867258.

Encore is an audio recording of this call that can be accessed by dialing 1-855-859-2056 and entering the Conference ID beginning 2 hours after the call has ended. The recording expires after 2 business days.

For ODF schedule updates and E-Mailing List registration, visit the ODF website

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PECOS Delay – Official Announcement

CMS has added  an MLN Matters article about the PECOS delay which was announced earlier this week.  It is titled:  SE1305 – Full Implementation of Edits on the Ordering/Referring Providers in Medicare Part B, DME, and Part A Home Health Agency (HHA) Claims (Change Requests 6417, 6421, 6696, and 6856).

NAHC  has posed the following questions to CMS:

  1. Must home health agencies issue a beneficiary notice to patients whose services will be terminated because of failure of their physician to be enrolled in PECOS and, if so, what notice?
  2. May home health agencies hold beneficiaries liable for the cost of care?
  3. Do apostrophes appear in PECOS files and in the edit files that will be used by the MACs (conflicting guidance from CMS to providers about use of apostrophes)
  4. Will claims be edited against the original Phase 2 May 1, 2013 “from” date or will this date be amended?
  5. Would CMS please add the effective date of physician enrollment to the Ordering/Referring File?

The Alliance appreciates NAHC pushing for these answers and will share information as we get it.

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NHIC Ask the Contractor April 25

Your opportunity to ask questions!

NHIC Corp., the regional Medicare Administrative Contractor, will host a Hospice & Home Health Ask the Contractor Teleconference (ACT) on April 25th, at 10:00 a.m.  This ACT Teleconference is an opportunity to speak directly with the contractor and ask questions or ask for clarification to an issue.  NHIC staff representing a variety of functions will be available to answer questions. NHIC usually will provide some updates to the home health and hospice community but the majority of this call is dedicated to providers as a question and answer open forum.

Registration is required on NHIC’s Education Programs webpage

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NHIC Ask the Contractor April 25

Save the Date

NHIC Corp., the regional Medicare Administrative Contractor, will host a Hospice & Home Health Ask the Contractor Teleconference (ACT) on April 25th, at 10:00 a.m.  This ACT Teleconference is an opportunity to speak directly with the contractor.  NHIC staff representing a variety of functions will be available to answer questions. NHIC usually will provide some updates to the home health and hospice community but the majority of this call is dedicated to providers as a question and answer open forum.

Registration is required on NHIC’s Education Programs webpage

Return to www.thinkhomecare.org.

Neighborhood Health Plan Drops Out of Dual Eligible Demonstration

Neighborhood Health Plan announced to partnering providers and organizations that they are withdrawing from the Dual Eligible Demonstration Project as an ICO, or Integrated Care Organization.

NHP was one of six groups that were working to become an ICO, but dropped out due to concern about payment rates conveyed from the state’s Executive Office of Health and Human Services (EOHHS) and the federal Centers for Medicare and Medicaid Services (CMS).

“EOHHS and CMS have acted in good faith to mitigate many of the factors involved in the rate discussions and unfortunately, for NHP, the final proposed rate structure, as projected, would result in substantial losses for NHP,” stated the emailed announcement.  “We feel that it is in our best interest at this time not to pursue the Duals demonstration further.”

The Home Care Alliance  spoke with NHP and met with other potential ICO’s with most expressing concern about the rates of payment. For months, stakeholders have been told that providers will receive no less than Medicare payments for Medicare services and no less than Medicaid payments for Medicaid services, but it is unclear if that is the case.

The Home Care Alliance will be attending the next “open stakeholder” meeting on April 19th in Shrewsbury to obtain more information.

“We strongly believe in the potential of truly integrated care models to improve care for the dually eligible and all Medicaid populations,” the NHP statement continued. “We wish your organization and the remaining ICOs much success.”

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CMS Issues Fact Sheet-Jimmo Lawsuit

CMS has recently issued a Fact Sheet on the Jimmo v. Sebelius Settlement Agreement. The settlement agreement puts an end to the Medicare contractors inappropriately applying an “Improvement Standard” in making claims determinations for Medicare coverage involving skilled care. ”It is intended to clarify that when skilled services are required in order to provide care that is reasonable and necessary to prevent or slow further deterioration, coverage cannot be denied based on the absence of potential for improvement or restoration”.  

Forthcoming Activities:

1)     Clarifying Policy-Updating Program Manuals:  This is the first action CMS will undertake as specified in the settlement agreement, revising the relevant program manuals used by Medicare Contractors

2)     Educational Campaign-Informing Stakeholders:  CMS will conduct national conference calls with providers and suppliers, as well as, Medicare contractors, Administrative Law Judges, medical reviewers, and agency staff, to communicate the policy clarifications and answer questions. CMS will also begin an educational campaign for contractors, adjudicators, and providers and suppliers utilizing a variety of written materials, including:

• Program Transmittal;

• Medicare Learning Network (MLN) Matters article;

• Updated 1-800 MEDICARE scripts.

3)     Claims Review:  CMS will engage in accountability measures, including review of a random sample of home health coverage decisions to determine overall trends and identify any problems, as well as, a review of individual claims determinations that may not have been made in accordance with the principles set forth in the agreement.

According to the terms of the settlement agreement, CMS will complete the manual revisions and educational campaign by January 23, 2014, which is within one year of the approval date of the settlement agreement.

 

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CMS Rescinds Reporting Modifier for Home Health Claims

Good news for Home Health Agencies…

CMS will no longer require home health agencies to apply a modifier to changes/additions to the plan of care by a physician other than the certifying physician for episodes starting on or after July 1. That’s the result of an April 3rd transmittal published on the CMS website. CMS states, “Transmittal 2650, dated February 1, 2013, is being rescinded and replaced with Transmittal 2680, to remove… instructions regarding reporting a new modifier.”

HHA are still required, effective July1, to report on claims the location where services were provided using one of three Q-codes.

  • Q5001: Home health care provided in patient’s home/residence
  • Q5002: Home health care provided in assisted living facility
  • Q5009: Home health care provided in place not otherwise specified

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CMS Notification: April 2013 Quarterly System Release – Claim Hold

CMS issued the following notification; home health final claims with a through date of April 1st or after will not be released into processing until April 15th; this is due to a problem with the quarterly release that will not be fixed until April 14th.

The Centers for Medicare & Medicaid Services (CMS) has identified technical issues with certain parts of the April 2013 quarterly systems release.  For claims with dates of service or “Through Dates” on or after April 1, 2013, the issues affect (1) all Home Health final claims, (2) outpatient Critical Access Hospital (CAH) and Rural Health Clinic (RHC) claims where dollars have been applied to the beneficiary deductible, and (3) the remittance advice summary payment amount for Medicare Advantage inpatient prospective payment system (IPPS) claims with indirect medical education (IME).  Actual payments and the claim-level payment amounts on the remittance advice are correct for these Medicare Advantage IPPS IME claims.  Final home health, outpatient CAH and RHC, and Medicare Advantage IPPS IME claims with dates of service or “Through Dates” prior to April 1, 2013, are unaffected.  In addition, for claims pending with or received by the Medicare claims administration contractors on or after April 1, 2013, the issues affect (1) all claims for assistant-at-surgery services, and (2) all Ambulatory Surgical Center claims.  As a result of these issues, CMS has instructed its Medicare claims administration contractors to hold all of these specific claim types until April 14, 2013, when system fixes are expected to be implemented.  These claims will be released into processing on April 15, 2013.  The claim hold should have minimal impact on provider cash flow because, under current law, clean electronic claims are not paid sooner than 14 calendar days (29 for paper claims) after the date of receipt.

CMS regrets any inconvenience and is working to resolve these issues as quickly as possible.

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