Tag: Home Health Care

OASIS-C1 is Here!

CMS has issued a Notice in the June 21st Federal Register announcing the proposed version of the OASIS–C1.  This draft of OASIS C-1 has 110 items and reflects changes to accommodate the need to enable the coding of diagnoses using the ICD-10-CM coding set which goes into effect October 1, 2014. The draft also reflects changes to address issues raised by stakeholders, such as updating clinical concepts and modifying item wording and response categories to improve item clarity; and to reduce burden associated with OASIS data collection by removing items not currently used by CMS for payment, quality, or risk adjustment. The draft also adds one new item M1011 (Inpatient diagnosis) at Recertification/Follow-up for the purposes of potential case-mix adjustment.

Comments on the draft OASIS-C1 must be received by August 20, 2013. When commenting,  reference the document identifier or OMB control number (OCN). To be assured consideration, comments and recommendations must be submitted in any one of the following ways:

  1. Electronically.

You may send your comments electronically to http://www.regulations.gov. Follow the instructions for ‘‘Comment or Submission’’ or ‘‘More Search Options’’ to find the information collection document(s) that are accepting comments.

  1. By regular mail.

You may mail written comments to the following address:

CMS, Office of Strategic Operations and Regulatory Affairs,

Division of Regulations Development,

Attention: Document Identifier/OMB Control Number__ Room C4–26–05,

7500 Security Boulevard, Baltimore,

Maryland 21244–1850.

The revised instrument, a table that compares the OASIS-C (Current Version) to the OASIS-C1 (Proposed Data Collection), and the supporting documentation can be found on CMS Paperwork Reduction Act (PRA) listing page, click here and scroll to CMS-R-245.

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CMS Competitive Bidding Program Starts July 1st

Starting on July 1, 2013, Medicare is scheduled to expand the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program to some areas in Massachusetts (Boston-Cambridge-Fall River-New Bedford- Quincy- Springfield-Worcester)  This program changes the amount Medicare pays for certain DMEPOS, and makes changes to which suppliers Medicare will pay to supply these items to Medicare beneficiaries.

To find out if a supplier is a contract supplier for the program check on the CMS DMEPOS Competitive Bidding Website for the “Supplier Directory” or by calling 1-800-MEDICARE (1-800-633-4227).

The eight product categories that are included in this program are:

1. Oxygen, oxygen equipment, and supplies;

2. Standard (power and manual) wheelchairs, scooters, and related accessories;

3. Enteral nutrients, equipment, and supplies;

4. Continuous Positive Airway Pressure (CPAP) devices, Respiratory Assist Devices (RADs) and related supplies and    accessories;

5. Hospital beds and related accessories;

6. Walkers and related accessories;

7. Support surfaces (Group 2 mattresses and overlays); and

8. Negative Pressure Wound Therapy pumps and related supplies and accessories.

 

For more information, CMS also published a Tip Sheet “What You Should Know if You Need Medicare-covered Equipment or Supplies”

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Home Care & Telemedicine

NPR’s Talk of the Nation had a lengthy segment on the growing use of telemedicine, especially in home care.  In addition discussing the benefits to patients with limited mobility or access to specific services they need and Medicare’s current refusal to reimburse for remote doctor consultations, the segment included a letter from the Alliance’s own James Fuccione, starting at 19’09”:

[HOST NEAL] CONAN: Here’s an email question that has some aspects of that that I wanted to ask you about, this from James [Fuccione] in Massachusetts: The Home Care Alliance of Massachusetts is advocating for Mass Health, [the] state Medicaid program, reimbursement of telehealth used by home health agencies.

Many agencies part of our association use telehealth already because it improves their quality and efficiency. They use wireless weight scales, blood oximeter, blood pressure cuffs, et cetera, and depending on their condition. So in other words you can collect data over these same circuits.

[DR. KAREN] EDISON: Right.

CONAN: Do you use that as well?

EDISON: Yes, so we do a lot of telehome care and remote monitoring here in Missouri. One of our large home health agencies in the southwest part of the state is probably the leader in that area. One of the challenges, of course, is the inter-operability of the health information systems. So as health information technology matures, and the companies become more inter-operable, they can talk to each other and transmit information easily.

You know, as that gets – as that whole industry matures, this is going to get easier and easier so that instead of the home health agency monitoring those patients, actually the patients – patient-centered health care home or medical home, their actual health providers would be monitoring those patients on a daily basis.

You may download the entire show by clicking here.

HCA Celebrates National Nurses Week

The Home Care Alliance is proud to join associations and medical providers from across the state and country in celebrating National Nurses Week.

Every year on May 6-12, National Nurses Week raises awareness of the value of nursing and the hard work performed everyday by nurses in all health care settings. In particular, the Home Care Alliance thanks the nurses working in home health care – along with the therapists, social workers, aides and other staff that are part of the care team with nurses – to ensure that people can remain at home for as long as possible.

Recently, the Home Care Alliance held the annual Home Care Innovations Showcase and Star Awards where the association recognized Patricia Darling from the Visiting Nurse Association of Boston and Shirley Lucier of VNA Care Network  with HCA’s “Clinician of the Year” awards. Many of the Innovation Awards to home health agencies recognized forward-thinking practices or policies that involved nurses as a vital component.

For those looking to join in recognizing nurses, the American Nurses Association hosts a special National Nurses Week website with resources and reports on the nursing profession and how to celebrate.

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Congratulations to the 2013 Star Award Winners

Each year, the Home Care Alliance of Massachusetts honors the best and brightest in caregiving and home care management. This video of the 2013 winners played at our award ceremony on May 1, 2013.

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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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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

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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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