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SNAP SHOT
HOSPICE: Is Your Agency Using Site of Service Codes (Q Codes) Correctly? —There has been some confusion about using the appropriate site on service codes for Hospice patients who reside in a SNF. Please see the guidance below from the Hospice Medicare Claims Manual:
Q5004 shall be used for hospice patients in a skilled nursing facility (SNF), or hospice patients in the SNF portion of a dually-certified nursing facility. There are 4 situations where this would occur:
1) If the beneficiary is receiving hospice care in a solely-certified SNF.
2) If the beneficiary is receiving general inpatient care in the SNF.
3) If the beneficiary is in a SNF receiving SNF care under the Medicare SNF benefit for a condition unrelated to the terminal illness and related conditions, and is receiving hospice routine home care; this is uncommon.
4) If the beneficiary is receiving inpatient respite care in a SNF.
If a beneficiary is in a nursing facility but doesn’t meet the criteria above for Q5004, the site shall be coded as Q5003, for a long term care nursing facility.
HOSPICE: Hospice Advocates Push for CMS to Delay Medicare Advantage Carve-In, Hospice News, December 16, 2019
HOSPICE and HOME HEALTH: Changes to Emergency Preparedness Requirements, NAHC Report, December 16, 2019 – A recent final rule released by CMS relating to burden reduction includes welcome changes to emergency preparedness requirements. The final rule, Regulatory Provisions to Promote Program Efficiency, Transparency, and Burden Reduction; Fire Safety Requirements for Certain Dialysis Facilities; Hospital and Critical Access Hospital (CAH) Changes to Promote Innovation, Flexibility, and Improvement in Patient Care became effective November 29, 2019. The changes to the emergency preparedness requirements apply to both home health and hospice providers and are outlined in this article.
HOME HEALTH and HOSPICE: MBI Transition Ends This Month: Will You Be Paid On January 1? – Palmetto GBA – The 21 month transition period will end on December 31; use Medicare Beneficiary identifiers (MBIs) now! Please read, Most HICN Claims Reject Regardless of Date Service
HOME HEALTH: ODM November Electronic Visit Verification Newsletter Is Now Available. Issue 20 November 2019 – Topics of interest are the Alternate EVV System Demonstrations and the Phase 3 timeline.
>>>RCD UPDATES –
OCHCH Members: Thank you very much for participating in OCHCH’s December 13th 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.
Next OCHCH Weekly RCD Conference Call - Friday, DECEMBER 20, 2019 at 10am!
We will not be scheduling any calls during the holidays. This means that the first 2020 Weekly RCD Conference Call will be on Friday, January 10, 2020 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 and into 2020 will remain the same:
Login - https://web.telspan.com/go/ochch/ochchpdgm
or
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 and December 6th are available in the RCD Toolkit.
DO YOU HAVE A RCD QUESTION?
FOLLOW THESE INSTRUCTIONS FOR THE QUICKEST WAY TO A LIVE RCD AGENT.
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 and call-in information has not been posted.
Quarterly Review Choice Demonstration (RCD) Medical Review Teleconference Schedule – Next date is March 11, 2020.
PDGM and the Review Choice Demonstration (RCD) – When PDGM starts, HHAs in the Pre-Claim Review (PCR) option will need to submit a PCR request for each 30-day period.
>>> PDGM UPDATES –
OCHCH Members: Thank you very much for participating in OCHCH’s December 10th PDGM WEEKLY CALL!
OPERATION: tackle PDGM
The OCHCH campaign to support your agency’s PDGM needs is up and running!
The second OCHCH Weekly PDGM Conference Call is(was) TODAY – Tuesday, DECEMBER 17, 2019 at 3pm!
We will not be scheduling any calls during the holidays. This means that the first 2020 Weekly PDGM Conference Call will be on Tuesday, January 7, 2020 at 3pm.
DON’T MISS THIS OPPORTUNITY!! Please mark your calendars for EVERY TUESDAY @ 3pm. The calls will last no more than an hour.
Login – https://web.telspan.com/go/ochch/weeklypdgm
OR
Call-in>
Dial: 888-392-4564
Enter: 1115130#
**This PDGM login/call-in information will be the same for each week**
If you have trouble getting on the Call – PLEASE CALL OCHCH 1-614-885-0434 Ext.206, or e-mail ryan@ochch.org
Check out the updated PDGM 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 “PDGM Toolkit.”
If you have questions PLEASE contact OCHCH by using helpdesk@ochch.org and use subject title, “PDGM,” OR call 614-885-0434 Ext 209.
In addition to the weekly PDGM calls, Beth Foster and Kathy Royer have been and will continue to answer PDGM questions.
OCHCH has 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.
New NAHC Webinar: Last-Minute Tips to Master PDGM, NAHC Report, December 16, 2019 – The Home Health and Financial Managers Association will provide a special live Update with the Experts to provide all home health operators with a final presentation on how to prepare for the Patient Driven Groupings Model (PDGM) when it takes effect on the first day of the new year. This special live Update with the Experts is free to all and will take place on Wednesday, December 18, 2019 from 1:00 PM to 2:00 PM Eastern.
Home Health Prospective Payment System (HH PPS) vs Patient-Driven Groupings Model (PDGM) Job Aid – CMS has a new case-mix classification model, the Patient-Driven Groupings Model (PDGM), effective beginning January 1, 2020. Check out the information in this updated job aid to find out how this new model compares with the Home Health Prospective Payment System (HH PPS).
The following two webcasts were hosted by the MACs:
Recording of the Home Health Patient-Driven Groupings Model (PDGM) Webcast Part I: November 21, 2019 is available, but new viewers need to register to view it
Recording of the Home Health Patient-Driven Groupings Model (PDGM) Webcast Part Two: December 5, 2019 is available. Please share this information with your staff.
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.
OASIS Considerations for Medicare PDGM Patients – This document provides PDGM transition guidance for OASIS time points.
October 2019 CMS Quarterly OASIS Q&As – Please note that guidance Q&As related to PDGM will become effective with assessments with a M0090 date of January 1, 2020 or later. Pages 1 through 10 address PDGM related questions.
OUR TAKE – Beth Foster, RN, BA, CPHQ, CEHCH
“Wondering if anyone has transmitted OASIS through iQIES and how it went!”
This question was posted to the OCHCH listserv and responses varied from no problems to several big issues. A member agency has been in a pending role since mid-December, and another is unable to save the assessments.
WHO DO YOU CALL?
I called Keith Weaver the Ohio Dept. of Health Automation specialist.
You can call Keith at 1-614-995-7898 or e-mail him keith.weaver@odh.ohio.gov. Keith will assist you by trouble shooting. If he is unable to assist you he will find someone that can!
Keep me informed of any issues with iQIES. The OCHCH Regulatory Department (Kathy Royer and I) are ready to assist you!
Beth Foster, RN, BA, CPHQ, CEHCH
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