Bulletin: December 17th, 2019

December 17th, 2019

   
 

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

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

HelpDesk Question of the Week

 
  Helpdesk Question of the Week –
HOME HEALTH: PDGM Question

Question: If a patient is admitted to the hospital for an in-patient stay, does that home health agency automatically discharge the patient.

Answer: The answer is it depends!  I found the answers in the October 2019 CMS Quarterly OASIS Q&As. Pages 1 – 10 address questions regarding OASIS under the new PDGM.

OASIS ANSWER 6: There is no change in the OASIS guidance in how agencies may use M0100 RFA 6 and 7 when a home health patient is admitted for an inpatient hospital stay. In the event that a patient had a qualifying hospital admission and was expected to return to your agency, you would complete RFA 6 – Transferred to an inpatient facility – not discharged from agency. If the patient was not expected to return to your agency after this inpatient facility stay, you would compete RFA 7- Transfer to an inpatient facility- patient discharged from agency.

However, if the patient required post-acute care in a SNF, IRF, LTCH or IPF prior to returning for home health services, CMS expects the home health agency to discharge the patient by completing the internal agency discharge paperwork and then to readmit the patient with a new Start of Care. This will allow appropriate admission status assignment for PDGM. There is no need to update or change the transfer OASIS to reflect this discharge.

If a home health patient is admitted directly to a SNF, IRF, LTCH or IPF for a qualifying stay (stays as an inpatient for 24 hours or longer for reasons other than diagnostic testing), you would complete RFA 7 – Transfer to an inpatient facility – patient discharged from agency, then readmit the patient with a new Start of Care if they were referred for further home health services.

OASIS ANSWER 7: When a patient returns home from an acute care hospital stay during the last 5 days of the current episode (days 56-60), the agency may complete only the Resumption of Care, allowing the assessment to serve both resumption and recert functions. However, if the patient required post-acute care in a SNF, IRF, LTCH or IPF prior to returning for home health services, CMS expects the home health agency to discharge the patient by completing the internal agency discharge paperwork and then to readmit the patient with a new Start of Care. This will allow appropriate admission status assignment for PDGM. There is no need to update or change the transfer OASIS to reflect this discharge.

   

   

Regulatory & Policy Digest

 

HOME HEALTH and HOSPICE: House Approves Health Workplace Violence Prevention Legislation, NAHC Report, December 11, 2019 – Last week the House of Representatives passed legislation extending employee protections against violence in the workplace. Introduced as the Workplace Violence Prevention for Heath Care and Social Service Workers Act, H.R. 1309, by Rep. Joe Courtney, the vote passed with a tally of 251 in favor and 158 opposed.

HOSPICE: Hospice Provider Preview Reports Now Available, CMS, December 16, 2019 – Hospice provider preview reports and Hospice Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Survey ® provider preview reports have been updated and are now available. These two separate reports are available in your Certification and Survey Provider Enhanced Reports (CASPER) non-validation reports folder. Hospice providers are encouraged to review their Hospice Item Set (HIS) quality measure results from Quarter 2, 2018 to Quarter 1, 2019 and their facility-level CAHPS® survey results from Quarter 2, 2017 to Quarter 1, 2019.

Providers have 30-days to review their HIS and CAHPS® results (Decembe16, 2019 through January 15, 2020) prior to the February 2020 Hospice Compare site refresh, during which this data will be publicly displayed. 
 
Should a provider believe the denominator or other HIS quality metric to be inaccurate or if there are errors within the results from the CAHPS® Survey data, a provider may request CMS review. Providers must adhere to the process outlined on the Public Reporting: HIS Preview Reports and Requests for CMS Review of HIS Data webpage and the Public Reporting: CAHPS® Preview Reports and Requests for CMS Review of CAHPS® Data webpage.
 
For more information on how to access these reports, view the HIS Preview Report Access Instructions and the Hospice CAHPS® Provider Preview Reports Access Instructions
 
HOME HEALTH: MedPAC Staff Recommend 7 Percent Cut in Medicare Payment to Home Health Providers, NAHC Report, December 11, 2019 – On December 5, the Medicare Payment Advisory Commission (MedPAC) convened for a session titled Assessing Payment Adequacy and Updating Payments: Home Health Care. This is an annual process where the commission receives a presentation evaluating payment adequacy for services rendered, as well as a report on patient access to home health services, and quality of care. Following the report, MedPAC staff offered their recommendation on home health payment adequacy. For 2021, MedPAC staff suggested a recommendation to the Congress of a seven percent reduction of the 2020 base payment rate.
 
 
HOME HEALTH: CMS Releases Info on New Home Infusion Therapy Benefit, NAHC Report, December 13, 2019 – A MLN SE article regarding the new Home Infusion Therapy (HIT) Benefit under Medicare Part B was recently released.  MLN SE19029 Medicare Part B Home Infusion Therapy Services With The Use of Durable Medical Equipment is intended for entities seeking accreditation to become qualified suppliers that furnish HIT services in coordination with the furnishing of home infusion drugs administered through an item of durable medical equipment (DME) beginning in calendar year 2021 and in subsequent years.
 

HOSPICE and HOME HEALTH: January 2020, Quarterly Release Temporary Hold, Palmetto GBA – Each quarter, the Fiscal Intermediary Shared System (FISS) is updated to include new logic for claims processing, pricing, etc. When the release is installed, Palmetto GBA places a temporary hold to ensure the release is installed properly. During this time, claims with dates of service of January 1, 2020, or later will be held in the status/location listed below and may be released before or on January 18, 2020, to continue processing. Please review this information and share it with your staff.

HOSPICE and HOME HEALTH: eServices MBI Be Prepared!, Palmetto GBA – This flyer includes information and reminders about using MBIs in eServices. Please review this information and share it with your staff.

HOSPICE and HOME HEALTH: Medicare Beneficiary Identifier (MBI) Lookup Tool, Palmetto GBA

HOSPICE and HOME HEALTH: Home Health and Hospice (HH&H) Medicare Quarterly Updates, Changes and Reminders Webcast Will Be Held on December 19 at 2 p.m. , Palmetto GBA

HOSPICE and HOME HEALTH: Ask the Contractor Teleconferences' (ACTs) Questions and Answers: October 22, 2019 are now available, 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


The dates are set for the 2020 Annual Conference!  Get extra socks, because we are going to knock them off again!

Save the Date: September 22nd and 23rd at the Hyatt Regency in Columbus, Ohio!

News Clips & Links

PALLIATIVE CARE: California's Palliative Care Rule a Potential Foundation for National Model, Hospice News, December 11, 2019
 
HOSPICE: More Deaths Now Occur in Homes than Hospitals, Nursing Facilities, Hospcie News, December 16, 2019


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