Bulletin: December 3rd, 2019

December 3rd, 2019



PALLATIVE CARE and HOSPICE: Primary Care First is Currently Accepting Practice Applications, CMS ListServe, December 2, 2019--The Primary Care First Request for Applications (RFA) was released on October 24, 2019, and the Application Portal is currently live and accepting applications. Applicants will need to register for an account to access the portal, and then may return to the application as often as needed. Practices interested in applying to Primary Care First should review the RFA to learn about the design and requirements of the model. The deadline to complete applications is January 22, 2020.


HOSPICE: OIG: Hospice Nurses Failed to Assess Aides in 99,000 Cases, Hospice News, December 2, 2019--Hospice nurses did not perform a home visit to assess the quality of care provided by hospice aides in an estimated 99,000 instances during 2016, according to a new report from the U.S. Department of Health & Human Services Office of the Inspector General (OIG). In another 5,000 cases the visits were not documented properly. 
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 RCD WEEKLY CALLS!
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.
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.
Call-in info through December 2019 will remain the same as all fo 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
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.”
The links to the RCD Call Recordings for the month of November are available in the RCD Toolkit.
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
Quarterly Review Choice Demonstration (RCD) Medical Review Teleconference Schedule – Next date is 12/11/2019


The following webcasts are(were) hosted by the MACs:

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.
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


Payments and Payment Adjustments under the Patient-Driven Groupings Model, Palmetto GBA – This article provides information on the implementation of the new Home Health Prospective Payment System (HH PPS) case-mix adjustment methodology named the Patient-Driven Groupings Model (PDGM). The PDGM will be implemented for home health periods of care starting on and after January 1, 2020.  This MLN Matters Number: SE19028 is a very comprehensive tool to share with staff so they develop a better understanding of the PDGM.
The OCHCH campaign to support your agency’s PDGM needs is up and running!
The first OCHCH Weekly PDGM Conference Call is Tuesday, DECEMBER 10, 2019 at 3pm!
DON’T MISS THIS OPPORTUNITY!! Please mark your calendars for EVERY TUESDAY @ 3pm. The calls will last no more than an hour.
Call-in info will be sent out through the listserv later this week.
In addition to the weekly PDGM calls, Kathy Royer and I have been and will continue to answer PDGM questions. By the way, the PDGM Toolkit had been 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 – Beth Foster, RN, BA, CPHQ, CEHCH
What is Livanta’s Memorandum of Agreement (MOA) for Healthcare Providers?
Livanta is a Beneficiary and Family Centered Care – Quality Improvement Organization (BFCC-QIO) that is responsible for medical case review, which supports the rights of individuals on Medicare in Ohio. These rights include protecting individuals when they receive health care and making sure they get the health care services the law says they can have. BFCC-QIOs can also help individuals with concerns about their care or if they request a review (appeal) of their discharge from a health care facility.
Home health and hospice agencies must inform individuals via the Notice of Medicare Non-Coverage (NOMNC, Form CMS-10123) at least 2 days prior to discharge that their care is ending. This gives individuals the time to request an expedited determination from Livanta. A Detailed Explanation of Non-Coverage (DENC) is given only if a beneficiary requests an expedited determination. The DENC explains the specific reasons for the end of covered services.
CMS restructured the BFCC-QIO regions effective on June 8, 2019 with Livanta covering Region 5 (OH, IN, IL, MI, MN, WI). At that time agencies should have been notified to complete a new Memorandum of Agreement (MOA) as required as a condition of your organization’s participation in Medicare.
If your organization has not yet submitted an MOA, or if you do not receive an email confirmation by October 1, 2019, please submit a signed MOA as soon as possible. As noted, MOAs are a Medicare requirement!
By the way – Livanta is required to report failures to complete the MOA directly to the CMS. To avoid this action, please complete your MOA as soon as possible. Livanta has set a deadline of December 31, 2019!!!






Beth Foster, RN, BA, CPHQ, CEHCH

HelpDesk Question of the Week

  Helpdesk Question of the Week –
Question: Our agency selected the Postpayment Review option.  How will PDGM affect us?
Answer: HHAs in the Postpayment Review option will receive an Additional Documentation Request (ADR) for each 30-day period.
HHAs in Choice 4, Selective Postpayment Review, and Choice 5, Spot Check Review may have an increase of reviews due to the 30 day periods.
FYI – Every six months, HHA’s may select from one of the three subsequent review choices if the pre- claim review affirmation rate or postpayment review approval rate is 90 percent or greater. The subsequent review choices are: Choice 1: Pre-claim Review;  Choice 4: Selective Postpayment Review; or Choice 5: Spot Check Review.



Regulatory & Policy Digest


PALLITIVE CARE and HOSPICE: Now Available: New and Updated Primary Care First Resources, CMS Listserve, December 2, 2019 CMS recently updated the model website to include links to the following products:

These materials may assist interested parties in understanding model requirements, the three payment model options, and their associated payment structures. Access these resources to help prepare your applications. Continue to visit the website frequently, as new materials will be posted as they become available.
HOSPICE: Reminder--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

HOME HEALTH: National Provider Survey of Home Health Agencies, NAHC Report, November 27, 2019 – Selected home health agencies will be receiving a survey requesting information on the use of the Centers for Medicare & Medicaid Services (CMS) performance measures in home health quality improvement programs. OCHCH and NAHC encourage agencies to participate in the survey if contacted. The information you provide will inform CMS on appropriate measure development and how measure performance data influences quality improvement programs within home health agencies.
HOME HEALTH and HOSPICE: Ask the Contractor Teleconferences' (ACTs) Questions and Answers: October 22, 2019 , Palmetto GBA – The October 22, 2019, Ask the Contractor (ACT) Questions and Answers are now available. Please review this information and share it with your staff.


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: Researchers Work to Expand Palliative Care Among Native Americans, Hospice News, December 2, 2019

HOSPICE: Hospices Embrace Direct-to-Consumer Marketing, Hospice News, December 2, 2019


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