Bulletin: November 26th, 2019

November 26th, 2019



PALLIATIVE CARE and HOSPICE: Predictive Analytics Can Help Hospices Reach Patients Sooner, Hospice News, November 18, 2019 – Predictive analytics systems are gaining ground in the hospice and palliative care fields as a means to identify patients in need of service earlier in the course of their illness.

HOSPICE: GAO Report Recommends CMS Receive More Authority to Enforce Safety Requirements on Hospice, NAHC Report, November 22, 2019 –  In recent months several reports examining aspects of the Medicare hospice benefit have been issued by oversight bodies including the Health and Human Services’ Office of the Inspector General (OIG). 
The report contains:

  • Comparisons of the number of Medicare hospice beneficiaries, beneficiary characteristics, and Medicare payments of for-profit and not-for-profit hospices;

  • Comparisons of hospice providers’ scores on the Centers for Medicare & Medicaid Services’ (CMS’) quality measures and other potential indicators of quality for for-profit and non-profit hospices; and

  • Discussion of opportunities for strengthening CMS’ oversight of hospice providers.

HOME HEALTH: HHAs: Avoid Payment Delays, Register for iQIES by December 23 Act now!
Home Health Agencies (HHAs) need access to the upgraded Internet Quality Improvement and Evaluation System (iQIES) to submit assessment data beginning January 1. CMS will return claims that cannot be matched to assessments, delaying your Medicare payments. See the MLN Connects Special Edition article SE 19025 for: Background, Step-by-step instructions, Training videos, FAQs, and How to get help

RCD UPDATES –                                                                                                                      

OCHCH Members: Thank you very much for participating in OCHCH’s November 22nd 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 22nd call you heard Charles Canaan, Palmetto GBA’s Provider Education Consultant discussed how PDGM is going to work with RCD, and answered numerous questions!
Click here to learn what PCR documents will be needed when PDGM is implemented on January 1, 2020
HOME HEALTH RCD Question: Encrypted Files
Question: Will Palmetto accept an encrypted file (pt. dob is password) when reviewing the PDFs we upload?  We cannot find anything in Palmetto's literature addressing this. We have emailed Palmetto as well and no response to date. 
If Palmetto is not able to accept encrypted files we need something in writing from them to provide to our Hospital System and Software Vendor. Our system encrypts the records automatically with the patient DOB as the password.
Answer from Palmetto GBA:  Currently there is not a way to submit an encrypted file in eServices
RCD Call Recording for 11/22/19 https://web.telspan.com/play/ochch/10415-ochch-rcd-call
The RCD Call Recordings are available on Friday afternoons.
Dial 855-696-0705
Press “0” at the main menu
Press “0” again
Press “3” for HHH
Press “1” for an RCD agent

REMINDER: 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 helpdesk@ochch.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, DECEMBER 6, 2019 at 10am!
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 all of the November calls:
Login - https://web.telspan.com/go/ochch/ochchpdgm
Dial: 888-392-4564
Passcode: 7896828#
If you have trouble getting on the Call – PLEASE CALL OCHCH 1-614-885-0434 Ext.206, or e-mail ryan@ochch.org


PDGM Questions & Answers from Palmetto GBA regarding when to discharge a patient and when to resume care when the patient goes into the hospital after 1/1/2020; and additional information on timing of institutional and hospitalizations and SNF admissions during an episode
Click here to access all the MLN Matters articles about PDGM.
The following webcasts are(were) hosted by the MACs:
Recording of the Home Health Patient-Driven Groupings Model (PDGM) Webcast Part I: November 21, 2019 is now available, but new viewers need to register to view it: https://event.on24.com/wcc/r/2102883/B5891153B2D7176F464B35EEBBC02B90

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.
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.

Our Take

 OUR TAKE – By Alexandra Weingarth Director of Policy and Advocacy 

 The Director of Aging, Ursel McElroy testified before the Ohio House of Representatives Aging and Long Term Care Committee last Thursday November 21st. She stated that:

  • Ohio is the sixth-largest 65-plus population in the nation.
  • There are approximately 2.8 million Ohioans over the age of 60.
  • Ohio’s 60-plus population is growing at a rate 28 times faster than the rest of the population

In our industry, we knew that this would be a hot topic within the executive branch and the legislature. The baby boomers are starting to age, and some would say the “silver tsunami” is approaching. Data supports that older adults prefer to age in their homes. Interestingly enough, The Director mentioned in her testimony that, “according to the US bureau of Labor Statistics, direct care workers (HH aides and personal care aides are the third and fourth fastest growing occupation in the county, yet the bureau notes that the low pay and high emotional stress demands cause workers to leave these occupations.”
We know that these occupations are on the rise, thus why we continuously work to urge government to reduce red tape regulations and consider making investments within the home health and hospice industries.
Additionally, the Director testified that the Ohio Department of Aging will be focusing on three priorities: Population Health, Economic Stability and Elder Justice. They will be looking at various ways of how to combat fraud waste and abuse, especially against older Ohioans.
For more information, please see the press release from the Ohio Department of Aging here.





Alexandra Weingarth | Director of Policy and Advocacy

Ohio Council for Home Care & Hospice

HelpDesk Question of the Week


Helpdesk Question of the Week –

PALLIATIVE CARE: Nurse Practitioner prescribing in the home
Question: Can a Nurse Practitioner prescribe narcotics to a Palliative Care patient while doing a home visit in the patient’s home residence?

Answer: From the Ohio Board of Nursing-

Section 4723.481, ORC and Rule 4723.9, OAC govern APRN prescribing and can be accessed through the links below. And I have pasted Section 4723.481 below, for your convenience.       
I.  To meet the requirements of 4723.481(C)(1), the CNP may prescribe a schedule II controlled substance to a patient if all of the following are the case:

(a) The patient has a terminal condition, as defined in section 2133.01 of the Revised Code.  [*Definition from 2133.01 (AA), ORC, is also pasted below for your convenience.]
(b) A physician initially prescribed the substance for the patient.
(c) The prescription is for an amount that does not exceed the amount necessary for the patient's use in a single, seventy-two-hour period.

*Section 2133.01, ORC,  Modified uniform rights of terminally ill act definitions, defines "Terminal condition" to mean an irreversible, incurable, and untreatable condition caused by disease, illness, or injury from which, to a reasonable degree of medical certainty as determined in accordance with reasonable medical standards by a declarant's or other patient's attending physician and one other physician who has examined the declarant or other patient, both of the following apply:   (1) There can be no recovery.   (2) Death is likely to occur within a relatively short time if life-sustaining treatment is not administered.
II. To meet the requirements of 4723.481(C)(2), the CNP may prescribe a schedule II controlled substance to a patient from any of the specific locations listed in (C)(2)(a) through (n).  You will see that a patient’s home is not one of the locations listed there. The only exception to that would be if the patient is in a hospice program and receiving hospice care in their home – see 4723.481(C)(2)(f).
While “from a hospice care program as defined in section 3712.01 of the Revised Code” is one of the allowed locations, that does not include palliative programs.


APRN Decision Model

APRN Prescribing Process

Issusing a Valid Prescription




Regulatory & Policy Digest


HOME HEALTH and HOSPICE: CMS Releases List of Potential Future Quality Measures, NAHC Report, November 21, 2019--The National Quality Forum (NQF) recently posted the list of Measures Under Consideration  (MUC) for future use in the hospice quality reporting program (HQRP) and the home health quality reporting program (HH QRP).

HOSPICE: Hospice Quality Reporting Program Forum Webinar — December 4, MLN Connects, November 21, 2019 – Learn about updates on the development of the Hospice Outcomes & Patient Evaluation (HOPE) Tool, including findings from focus group and electronic health record vendor listening sessions.
Wednesday, December 4 from 2 to 3 pm ET
Register for this webinar.
Target Audience: Medicare-certified hospice providers.


HOSPICE: CMS to Allow Hospices to Accept Medication Orders from Physician Assistants, Hospice News, November 20, 2019 – In a new final rule, the U.S. Centers for Medicare & Medicaid Services (CMS) will permit physician assistants to send medication orders to hospices. Previously, only orders from physicians or nurse practitioners were acceptable. 

HOSPICE: Hospice Notice of Election (NOE) Timely Filing and Exceptional Circumstances Guidelines, Palmetto GBA, November 6, 2019

HOME HEALTH: Local Coverage Determination (LCD) and Medical Coverage Database (MCD) Article Updates: Home Health and Hospice, Palmetto GBA – The Home Health-Surface Electrical Stimulation in the Treatment of Dysphagia L34565 HHH LCD was revised. The Billing and Coding: Home Health-Surface Electrical Stimulation in the Treatment of Dysphagia A56648 HHH MCD article was revised. Please review these revisions and share them with your staff

HOME HEALTH and HOSPICE: December 2019 JM Home Health and Hospice Medicare Advisory Palmetto GBA

HOME HEALTH and HOSPICE: Claim Status Category and Claim Status Codes Update, Palmetto GBA


HOME HEALTH and HOSPICE: Links:  Implement Operating Rules - Phase III Electronic Remittance Advice (ERA) Electronic Funds Transfer (EFT): Committee on Operating Rules for Information Exchange (CORE) 360 Uniform Use of Claim Adjustment Reason Codes (CARC), Remittance Advice Remark Codes (RARC) and Claim Adjustment Group Code (CAGC) Rule - Update from Council for Affordable Quality Healthcare (CAQH) CORE, Palmetto GBA

HOME HEALTH and HOSPICE: New Medicare Card: HICN Claims Reject January 1, 2020, Palmetto GBA

HOSPICE and HOME HEALTH: Hospice and Home Health Claims Processing Issues Log, Palmetto GBA

Upcoming Education & Events


For Upcoming webinars, conferences, workshops and events click HERE

Click Here to Register!


News Clips & Links

PALLIATIVE CARE and HOSPICE: Hospices, Palliative Providers Innovate to Better Serve Rural Patients, Hospice News, November 25, 2019

HOSPICE: The Top 10 Largest Hospice Providers of 2019, Hospice News, November 20, 2019
HOSPICE: Misconceptions About Hospice Care Persist Among U.S. Public, Hospice News, November 18, 2019

HOSPICE: New Penn Research Center Focused on Palliative Care for Dementia Patients, Hospice News, November 25, 2019


Ohio Council for Home Care & Hospice  1105 Schrock Rd., Suite 120, Columbus, OH 43229
(614) 885-0434   www.ochch.org