Bulletin: December 23rd, 2019

December 23rd, 2019



HOSPICE: CMS Releases Long-awaited Details on MA/Hospice Carve-in Demonstration Planned for CY2021, NAHC List Serve, December 20, 2019--Late December 19, the Centers for Medicare & Medicaid Services (CMS) issued a Request for Applications (RFA) for the Value-Based Insurance Design (VBID) Model Incorporation of the Medicare Hospice Benefit into Medicare Advantage (MA), through which it is seeking participation by MA plans.

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
CMS Provides Compliance Tip Sheet for Home Health Agencies and Physicians, NAHC Report, December 18, 2019 – CMS recently released a MLN Fact Sheet, Provider Compliance Tips for Home Health Services (Part A Non-DRG). According to CMS, “Insufficient documentation accounted for a large proportion of improper payments for home health services. The primary reason for these errors was that the documentation to support the certification of home health eligibility requirements was missing or insufficient. Medicare coverage of home health services requires physician certification of the beneficiary’s eligibility for the home health benefit.”
This tip sheet is for physicians who refer beneficiaries to home health, order home health services, and/or certify beneficiaries’ eligibility for the Medicare home health benefit; home health agencies; and non-physician practitioners (NPPs). It outlines the requirements for the physician certification including the face-to-face (F2F) component. There are no new requirements, but agencies may find the tip sheet helpful in communicating the requirements to physicians, referring parties and their staffs.

>>>RCD UPDATES –                                                                                                                  

OCHCH Members: Thank you very much for participating in OCHCH’s December 20th 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, JANUARY 10, 2020 at 10am!
We will not be scheduling any calls during the holidays.
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
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.
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.


OCHCH Members: Thank you very much for participating in OCHCH’s December 17th PDGM WEEKLY CALL!
The OCHCH campaign to support your agency’s PDGM needs is up and running!
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
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.

Recording of the HHFMA Call With the Experts—PDGM: December 18, 2019 is available.  Industry experts discuss best practices as agencies prepare for PDGM
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.

HelpDesk Question of the Week


Helpdesk Question of the Week –
HOSPICE: Place of Service Codes (Q Codes)

Question: What place of service code should be used for a hospice patient who resides in a SNF and is receiving routine home care?

Answer: 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.



Regulatory & Policy Digest


HOSPICE: Reminder--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

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: January 2020 JM Home Health and Hospice Medicare Advisory, Palmetto GBA
HOSPICE and HOME HEALTH: January 2020 Release Dark Days for the Common Working File (CWF) Hosts, 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

HOSPICE: Humana Agrees to Purchase Hospice Pharmacy Provider Enclara, Hospice News, December 18, 2019
HOSPICE: Interim Healthcare Finds Winning Strategy on Staff Retention, Hospice News, December 18, 2019

HOSPICE: Hospice Mergers and Acquisitions Outlook for 2020, Hospice News, December 18. 2019

HOSPICE: Looking Ahead: Hospice in 2020, Hospice News, December 23, 2019

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