Tag: CMS

Centers for Medicare & Medicaid Services

Hospice Reporting Reminder- Deadline April 1st

The following is a noticed released by CMS last week reminding Hospice Providers of the April 1st deadline for submission of the hospice pain measures (NQF #0209). 

Hospice Quality Reporting Program: NQF #0209 Deadline April 1

Important Alert: The deadline to submit the NQF #0209 data is quickly approaching. Hospices that fail to submit and attest to their data will receive a 2 percentage point reduction in their Annual Payment Update (APU) for the FY 2014.

To comply with the Payment Year 2014 Hospice Quality Reporting Program (HQRP) requirements, providers should currently be entering their NQF #0209 data on the data entry and submission website. Providers that have not already created a data entry account should do so now.

The deadline for reporting NQF #0209 data for Payment Year 2014 is April 1, 2013. In order to avoid a 2 percentage point reduction in their Annual Payment Update (APU), providers must have submitted their structural measure data by January 31, 2013 and must submit their NQF #0209 data by April 1. Providers that may have missed the structural measure deadline can still visit the data entry website, create an account, and enter their NQF #0209 data. The link to the data entry site, along with a Technical User Guide giving step-by-step instructions on the data entry process, can be found on the Data Submission portion of the CMS HQRP website.

User Account Deactivation Requests for the HQRP

If you anticipate needing a deactivation request for your HQRP user account, please submit the user account deactivation request to the Technical Help Desk via fax at 888-477-7871 or email at help@QTSO.com prior to March 25, 2013. Any deactivation requests received on or after March 25 puts a hospice organization at risk for missing the NQF #0209 deadline, which is April 1. Please note: all data submitted by a user who is deactivated is permanently deleted.

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CDC and CMS Alert – “Super-bug” CRE on the Rise

Infections with the deadly Carbapenem-Resistant Enterobacteriaceae (CRE) are on the rise in hospitals nationwide, and are a serious threat to public health according to the Centers for Disease Control and Prevention (CDC). Due to the movement of patients throughout the healthcare system, if CRE are a problem in one facility, then typically they are a problem in other facilities in the region as well as in the home. Home health agencies may want to alert staff about CRE and steps to take if an infection is suspected.

CDC and CMS Sound Alarm on “Nightmare” Bacteria

The Centers for Disease Control and Prevention (CDC) and CMS are asking your assistance in tackling what may be one of the most pressing patient safety threats of our time—carbapenem-resistant Enterobacteriaceae (CRE). CDC recently released a report on the presence of CRE in U.S. inpatient medical facilities, demonstrating that action is needed now to halt the spread of these deadly bacteria. We are asking for rapid action from healthcare leaders to ensure that infection prevention measures are aggressively implemented in your facilities and those around you.

Enterobacteriaceae are a family of more than 70 bacteria, including Klebsiella pneumoniae and E. coli, that normally live in the digestive system. Over time, some of these bacteria have become resistant to a group of antibiotics known as carbapenems, often referred to as last-resort antibiotics. During the last decade, CDC has tracked one type of CRE from a single healthcare facility to facilities in at least 42 states. In some healthcare facilities, these bacteria already pose a routine threat to patients.

CDC has released a concise, practical CRE prevention toolkit with recommendations for controlling CRE transmission in hospitals, long-term acute care facilities, nursing homes, and health departments. Key recommendations follow CDC’s “Detect and Protect” strategy, including:

  • Enforcing use of infection control precautions (standard and contact precautions).
  • Grouping patients with CRE together.
  • Dedicating rooms, staff, and equipment to the care of patients with CRE whenever possible.
  • Having facilities alert each other when patients with CRE transfer back and forth.
  • Asking patients whether they have recently received care somewhere else (including another country).
  • Using antibiotics wisely.

When fully implemented, CDC recommendations have been proven to work. Medical facilities in several states have reduced CRE infection rates by following CDC’s prevention guidelines.

The United States is at a critical point in our ability to stop the spread of CRE. If we do not act quickly, we will miss our window of opportunity and CRE could become widespread across the country.

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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.

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February ODF

The next Home Health, Hospice & Durable Medical Equipment  Open Door Forum is scheduled for Wednesday, February 20, 2013 from 2:00pm – 3:00pm, ET.  To participate by phone, dial 1-800-837-1935; Conference ID: 78869441. The agenda will be posted before the call on the ODF Website

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ICD-10: Take Readiness Survey

CMS and the Workgroup on Electronic Data Interchange (WEDI) are conducting a survey on healthcare industry readiness for ICD-10. The purpose of the survey is to closely track industry progress in order to identify areas where additional focus may be needed. The survey is open through Wednesday, February 20, 2013 and available to any individual associated with health care organizations

The online survey, located at https://www.surveymonkey.com/s/WEDISurveyICD-10, will be used by WEDI and the Centers for Medicare & Medicaid Services to evaluate challenges and identify areas in need of additional education and assistance. This is a great opportunity to provide input about your readiness for the ICD-10 transition in 2014.

WEDI’s Survey on Industry Progress Now Open

The Workgroup for Electronic Data Interchange (WEDI) is conducting its latest online ICD-10 Industry Progress Survey. The survey will help CMS and WEDI:

  • Measure the health care industry’s ICD-10 progress
  • Evaluate challenges and identify areas where industry needs more education and assistance

The survey is open to all individuals associated with health care organizations, including vendors, health plans, providers, and payers.

Before taking the online survey, please scroll to the link at the end of the WEDI survey press release to preview the questions. The press release also includes a link to the online survey form.

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Invitation to Comment on QIO Changes

CMS’s Center for Clinical Standards and Quality (CCSQ) is inviting providers to offer input on plans for redesigning the Quality Improvement Organization (QIO) Program. By law, the mission of the QIO Program is to improve the effectiveness, efficiency, economy, and quality of services delivered to Medicare beneficiaries. QIOs convene providers, practitioners, and patients to build and share knowledge, spread best practices, and achieve wide-scale improvements in patient care, increases in population health, and decreases in health care costs.

CMS has just released the slides from the January 24th Special Open Door Forum, Future Development of the QIO: Getting Your Feedback.  This invitation to provide comments on the future development of the QIO is an excellent opportunity for home health agencies to request the support and resources they deserve in the QIO program. Home health has been left out of the last two Scope of Work (SOW) plans, which focused on hospital and skilled nursing facilities. The 8th SOW was the last time the QIO focused on home health.

Home health agencies should write to CMS and advise them of ways that QIOs can provide home care with guidance and tools to effectively care for the millions of Medicare beneficiaries they serve, help them learn to comply with their treatment regimens, trouble shoot  potential complications, and avoid costly emergent care and institutional services, as well as expand their involvement in preventative services,

Please share your comments and ideas on the role Quality Improvement Organizations can play in home health.  Submit your comments to OCSQBox@cms.hhs.gov by Friday, February 8th at 5:00 p.m. ET

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New Edits on Hospice Claims

Recently, CMS released Change Request (CR) 8142 – Hospice Monthly Billing Requirement, effective date of change- July 1, 2013. The CR instructs Medicare contractors to implement a system edit to return hospice claims to the provider when there is more than one hospice claim per month per beneficiary. The only exception to this requirement is in the case of the beneficiary being discharged or revoking the benefit and then later re-electing the benefit during the same month.

Medicare contractors will also implement a system edit when the provider submits claims that span more than one calendar month.  Any hospice claim spanning multiple months will be returned to the provider for correction.

This is not new policy but is a new enforcement.  After July 1, 2013 claims not in compliance with the monthly billing requirement will be returned to providers.  A corresponding MedLearn Matters article is expected to be posted in the near future.

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Judge Approves ‘Improvement Standard’ Settlement

On January 24, 2013, the Chief Judge of Vermont’s U.S. District Court gave her approval  during a scheduled fairness hearing for an ‘improvement standard’ settlement (Jimmo v. Sebelius).  This settlement could lead to more long-term care in the home health setting and open the benefit to patients who were previously denied coverage.

According to The Center for Medicare Advocacy, that helped litigate the case on behalf of beneficiaries, “With the settlement now officially approved, the Centers for Medicare & Medicaid Services (CMS) is tasked with revising its Medicare Benefit Policy Manual and numerous other policies, guidelines and instructions to ensure that Medicare coverage is available for skilled maintenance services in the home health, nursing home and outpatients settings. CMS must also develop and implement a nationwide education campaign for all who make Medicare determinations to ensure that beneficiaries with chronic conditions are not denied coverage for critical services because their underlying conditions will not improve.”

It should be noted that the Settlement Agreement standards for Medicare coverage of skilled maintenance services applies immediately, The Center of Medicare Advocacy encourages people to appeal should they be denied Medicare coverage for skilled maintenance nursing or therapy because they are not improving.

For more information read, Judge Approves Settlement in Jimmo vs. Sebelius After Court Hearing

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January 31- Deadline for Submission of Structural Measure Data for Hospice

Reminder:   The deadline for attestation and submission of structural measure data for the Hospice Quality Reporting Program (HQRP) is Thursday, January 31, 2013.

Hospice providers that have not already created a user account and begun structural measure data entry should do so immediately. The link to the data entry site is available on the Data Submission portion of the HQRP website at the bottom of the webpage under “Related Links.” For step-by-step guidance on account creation, account activation, data entry and data submission, refer to the Technical User’s Guide for Hospice Quality Reporting Data Entry and Submission

For any questions about using the Hospice Quality Reporting Data Entry and Submission Site  contact the QIES Technical Support Office Help-desk by phone at 1-877-201-4721 or email at help@qtso.com

Technical Help-Desk hours are 8:00 a.m. through 8:00 p.m. ET.

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REMINDERS RE ACCOUNT ACTIVATION AND DATA SUBMISSION

Hospice Information from CMS ––

CMS requested that providers are reminded about registering for accounts for the Hospice Quality Reporting Program – the text follows.

Hospice Quality Reporting Program Data Entry/Submission Website now Available

Structural Measure Data Submission Deadline 1/31/13

 The data entry site for Hospice Quality Reporting Program (HQRP) data submission is live and active for provider use. The link to the data entry site is available on the Data Submission portion of the CMS HQRP website under “Related Links.” As providers may experience unexpected technical issues when registering for/activating their account, providers should not wait until all of their data is compiled to register for and activate their account. Early account creation and activation will help ensure that providers do not miss the 1/31/13 deadline for the structural measure. In order to meet the 1/31/13 structural measure deadline, providers should:

  1. Review the Technical User Guide for Hospice Quality Reporting Data Entry and Submission located on the CMS Hospice Quality Reporting Data Submission web page. It is imperative that providers review the Guide prior to registering for a user account. The Guide provides step-by-step instruction on registration, data entry, and submission of hospice quality reporting data. Also available is the Hospice Quality Reporting Program Data Entry and Submission WebEx recording. The recording is available on the Hospice Training page of the QTSO website.
  2. Register for a User Account. Visit the data entry website and create an account. Please note, hospice organizations will only be allowed one user account per CMS Certification Number (CCN). Hospices should carefully select the ONE individual that will enter required quality data for both measures. Thus, if you do not intend to complete the tasks of registration, data entry, attestation and submission for a specific hospice provider, please do not register for an account.
    Providers should register for an account now, even if they are not ready to submit their data immediately.
  1. Activate the User Account. After registering for an account, providers will receive a registration activation email from hospice.quality.report@GDIT.com to activate their account. To activate your account you must click on the link in the body of the email. If the Hospice Registration Activation E-mail is not received, please take the following steps:
    1. If you have more than one e-mail address, check all your email accounts in case you registered with a different account.
    2. If the activation email has not been received at any of your email accounts, take the following steps for each account:
      1. Check all your Mail folders, not just your inbox.
      2.  Look in any folders marked Junk or Spam for an e-mail from hospice.quality.report@GDIT.com.
      3. If you do not have access to a Junk or Spam folder, check with your e-mail technical support staff to see if your mail server may have trapped the e-mail.
      4. If you are unable to locate the e-mail, contact the QIES Help Desk at help@qtso.com for a Deactivation Form.
      5. Once you receive the Deactivation Form, fill it out completely and return it to the address on the form. Your registration attempt will be removed and you will be notified when you can register once again.  We strongly recommend you use a different e-mail address for the new registration.
  2. Once the account is activated, login and complete the Hospice Provider Information page on the data entry website.
  3. Enter your structural measure and NQF #0209 data. Providers do not have to enter all of their data in one sitting. Data for both measures can be saved on the data entry website and returned to at a later date.
  4. Attest to and submit data to CMS through the data entry website. Once your data entry for either measure is complete and accurate, submit and attest to the data for that measure.
    • Data for the structural measure must be attested to and submitted to CMS no later than January 31, 2013. Data for the NQF #0209 Pain Measure must be attested to and submitted to CMS no later than April 1, 2013.

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