HOSPICE and PALLIATIVE CARE: Advance Care Planning Does Not Reduce Health Care Utilization, Hospice News, November 13, 2019 – Although patients who have advance care plans have higher rates of hospice utilization, these plans do not reduce the likelihood that a patient would seek aggressive treatments at the end of life, a new study has found.
HOSPICE: Misconceptions About Hospice Care Persist Among U.S. Public, Hospice News, November 18, 2019 – A large proportion of U.S. adults continue to have a limited understanding of hospice care, and misperceptions continue to persist, according to a new MorseLife Hospice and Palliative Care survey.
HOME HEALTH: CMS Issues Manual Updates Related to PDGM, NAHC Report, November 15, 2019 – CMS has issued Change Request (CR) 11527, which includes further updates to the Claims Processing Manual, Chapter 10, related to the Patient Driven Grouper Model (PDGM). The CR clarifies that a beneficiary is not required to be discharged form home health services if an inpatient stay spans across two 30 day periods within a certification period. Also, the CR establishes a process to address 30 day periods where there are no visits because the POC requires visits less frequently than every 30 days.
HOME HEALTH: Home Health Prospective Payment System (HH PPS) Rate Update for Calendar Year (CY) 2020, Palmetto GBA – Change Request (CR) 11536 updates the CY 2020 60-day and 30-day base payment rates, the national per-visit amounts, Low-Utilization Payment Adjustment (LUPA) add-on amounts, the non-routine medical supply payment amounts, and the cost-per-unit payment amounts used for calculating outlier payments under the HH PPS. In addition, this CR revises the initial payment percentage for both initial and subsequent 30-day periods of care under the split percentage payment approach for CY 2020. Make sure that your billing staff is aware of these changes.
RCD UPDATES –
OCHCH Members: Thank you very much for participating in OCHCH’s November 15th RCD WEEKLY CALL!
OCHCH recently launched an awareness campaign to provide your agency with the assistance, information, resources, and training you need to tackle the challenges of RCD and PDGM. This campaign is called OPERATION: tackle.
As part of OPERATION: tackle we are hosting weekly conference calls on RCD that started on October 25th and will continue for the foreseeable future. These conference calls will provide an opportunity for us to share the latest developments of RCD, for you to share your challenges, and for our members to share best practices in a real time environment. On the November 15th call you heard Beth Foster and Kathy Royer sharing the top issues/questions received from the past week. Also, the OCHCH team answered your questions!
Friday afternoon, November 15th, the following information was shared on the Listserv as follow-up to the weekly OCHCH RCD Call:
FAQs 106. Question: If a patient is on home health service prior to the implementation of RCD and upon recertification they will need to submit a PCR request, what documentation from the past benefit periods will need to be submitted?
Answer: For all medical necessity reviews, the Medicare review contractors shall review the certification documentation for any episode initiated with the completion of a SOC OASIS. Therefore, if the subject claim is for a subsequent episode of care, the HHA must submit all certification documentation as well as recertification documentation.
Reference: CMS IOM Publication 100-08, Chapter 6, Section 6.2.1
Question: When submitting online there is a question that ask "is there a subsequent episode" and a radio dial yes or no - what is this question pertaining to?
Answer: If this is the first time submitting for a recert episode the HHA should click on NO, not yes to subsequent episode. Upload the F2F, initial referral info and initial signed POC along with the recert POC and associated visit documentation for the recert.
Since this answer is hard to understand, I decided to answer a different way that may be more helpful: If this recert was the first time you submitted a PCR request – there have been no other request so this recert has no other subsequent info in the system. The next time you submit a PCR request for a recert you will answer, Yes, because there is a subsequent recert in the system
Could you please share your best practices on getting required info (F2F, clinical note) from skilled nursing facilities?
OCHCH member response: The only thing we have seen helpful with SNF is meeting with the referring Staff especially the CNPs to fully explain what is needed and why and what terminology will be useful. So far small wins with about 2 locations but hopefully once we get to our more frequent referral SNFs it will be helpful. We provided a list of diagnosis that are not strong enough and also educated more on why "just a diagnosis" does not work for skilled need or homebound.
OCHCH would suggest: Home Health agencies to establish working relationships with SNF providers. This will allow the opportunity for Home Health providers to educate SNF providers regarding the documentation required for payment of Home Health services.
The RCD Demonstration started on September 30, 2019. All episodes of care, both initial and recertifications starting on or after this date are subject to the requirements of the choice selected.
DO YOU HAVE A RCD QUESTION?
FOLLOW THESE INSTRUCTIONS FOR THE QUICKEST WAY TO A LIVE RCD AGENT.
Press “0” at the main menu
Press “0” again
Press “3” for HHH
Press “1” for an RCD agent
All RCD provider questions must go through the Palmetto GBA Provider Contact Center (PCC) at 855-696-0705. However, if your questions are not being answered, you are not receiving a call back in a timely manner, or you need assistance to contact Palmetto GBA, PLEASE contact OCHCH by using firstname.lastname@example.org and use subject title, “RCD” and include the UTNs, OR call 614-885-0434 Ext 209.
Find RCD Answers through the updated October 16, 2019 Review Choice Demonstration (RCD) for Home Health Services Frequently Asked Questions (FAQs)
Monthly Review Choice Demonstration (RCD) Provider Teleconference Schedule – Next date is 12/04/2019
ATTENTION: Check out the updated RCD Toolkit located in the members’ section of the OCHCH site. Just login to “My Profile” and in the left column under “HELP DESK ONLINE” click on “RCD Toolkit.”
Next OCHCH Weekly RCD Conference Call - Friday, NOVEMBER 22, 2019 at 10am!
**Charles Canaan from Palmetto GBA will be on the call – so get your questions ready!!!**
DON’T MISS THIS OPPORTUNITY!! Please mark your calendars for EVERY FRIDAY @ 10am. The calls will last no more than an hour.
(No call on Friday, November 29 due to the Thanksgiving Holiday!)
Call-in info through December 2019 will remain the same as the Nov. 1st, 8th, & 15th call:
Login - https://web.telspan.com/go/ochch/ochchpdgm
If you have trouble getting on the Call – PLEASE CALL OCHCH 1-614-885-0434 Ext.206, or e-mail email@example.com
Talk to you soon!
>>> PDGM UPDATES –
The following webcasts are hosted by the MACs:
Home Health Patient-Driven Groupings Model (PDGM) Webcast Part One: November 21, 2019
This is the first of two collaborative webcasts about the Home Health Patient-Driven Groupings Model (PDGM), hosted by your Home Health Medicare Administrative Contractors (MACs), CGS, National Government Services and Palmetto GBA. This presentation will begin on Thursday, November 21, 2019 at 02:00 PM Eastern Standard Time. During this webcast, you will receive information to help your agency prepare to implement billing changes for the PDGM on January 1, 2020. PDGM is the Medicare payment model used to reimburse home health agencies. Please plan to attend.
Home Health Patient-Driven Groupings Model (PDGM) Webcast Part Two: December 5, 2019
This is second part of two collaborative webcasts about the Home Health Patient-Driven Groupings Model (PDGM), hosted by your Home Health Medicare Administrative Contractors (MACs), CGS, National Government Services and Palmetto GBA. This presentation will begin on Thursday, December 05, 2019 at 02:00 PM Eastern Standard Time. During this webcast, you will receive information to help your agency prepare to implement clinical changes for the PDGM on January 1, 2020. PDGM is the Medicare payment model used to reimburse home health agencies. Please plan to attend.
OUR TAKE – By Beth Foster, RN, BA, CPHQ, CEHCH
OPERATION: tackle PDGM
The OCHCH campaign to support your agency’s PDGM needs will be up and running the beginning of December. We will be scheduling weekly PDGM calls, and the helpdesk (Kathy and I) have been and will continue to answer PDGM questions. By the way, the PDGM Toolkit will be updated to include more links for you!!!
OCHCH will have a number of recordings available on our website of previous PDGM education webinars for your purchase or access. Moving forward OCHCH is committed to bringing you continued education on the implementation of PDGM and its impacts on our industry.
Beth Foster, RN, BA, CPHQ, CEHCH