Tag: Medicare

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 Health & Hospice ODF

The Centers for Medicare & Medicaid Services (CMS) will hold the next Home Health, Hospice & Durable Medical Equipment (DME) Open Door Forum on Wednesday, June 26th from 2:00pm – 3:00pm, ET. (The agenda has not yet been released)

If you wish to participate, dial 1-800-837-1935; Conference ID: 97842778.

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Guest Post: ICD-10 Preparedness – Where Are You in the Process?

Guest Post by: Joan L. Usher, BS, RHIA, COS-C, ACE

Medicare Certified Home Health Agencies need to implement their ICD-10 preparedness plans now.  This is the single largest change the health care system has seen since the inception of Medicare.  Changing to ICD-10 is not a simple coding change: it impacts every department in the organization.  Follow these 5 steps to develop your agency’s ICD-10 preparedness plan.

Organize

Establish a Steering Committee with key players from major departments.  The ease and success of the transition relies heavily on strong leadership support.

Assess

Assess the impact on all departments.  This step is crucial in determining which items need to be completed pre-ICD-10, including testing of claim submissions with ICD-10 codes, redesign of EHR screen, or paper documents to capture documentation needed. Consider vendor and payer readiness.  Determine how to operate dual systems, and for how long.  Assess coder’s knowledge of the current coding model.  Assess whether the coding model will work under the increased specificity of ICD-10. Continue reading “Guest Post: ICD-10 Preparedness – Where Are You in the Process?”

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.

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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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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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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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

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