Bulletin: January 7th, 2020

January 7th, 2020



HOME HEALTH and HOSPICE: Next Home Health, Hospice & DME Open Door Forum, CMS List Serve, January 3, 2020—The next Home Health and Hospice Open Door Forum is scheduled for:
Wednesday, January 8, 2020 PM at 2:00-3:00 PM Eastern Time (ET).  Please call at least 15 minutes prior to the forum start time.
Open Door Participation Instructions:
  • This call will be Conference Call Only.
  • To participate by phone:
  • Dial: 1-888-455-1397 & Reference Conference Passcode: 9375124
HOME HEALTH and HOSPICE: CMS to Host Important Overviews on Direct Contracting Models, NAHC Report, January 6, 2020 – The Center for Medicare and Medicaid Innovation (CMMI) will host two events on direct contracting models on January 7 and January 8, intending to provide an overview of the topic and answer questions about the model. In spring 2019, the Centers for Medicare & Medicaid Services (CMS) announced plans to test Direct Contracting models through its Center for Medicare & Medicaid Innovations (CMMI). Direct Contracting is a set of three voluntary payment model options aimed at reducing expenditures and preserving or enhancing quality of care for beneficiaries in Medicare fee-for-service (FFS). The payment model options available under Direct Contracting create opportunities for a broad range of organizations in testing the next evolution of risk-sharing arrangements to produce value and high quality health care. Building on lessons learned from initiatives involving Medicare Accountable Care Organizations (ACOs), such as the Medicare Shared Savings Program (MSSP) and the Next Generation ACO (NGACO) Model, the payment model options available under Direct Contracting also leverage innovative approaches from Medicare Advantage (MA) and private sector risk-sharing arrangements.
HOSPICE: VBID Model Request For Applications Released On December 19, 2019, NHPCO NewsBriefs, January 2, 2020 – The CMS Center for Medicare and Medicaid Innovation  released a Request for Applications (RFA) for an expansion of the Value-Based Insurance Design (VBID) Model that will allow Medicare Advantage plans to include hospice coverage in plan designs for the first time in 2021. This is an RFA for Medicare Advantage plans. Hospice providers are not eligible to apply but may be considered for in-network or out-of-network status as a provider.
HOME HEALTH: 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 –                                                                                                                  

ATTENTION: Review Choice Demonstration (RCD) for Home Health Services Frequently Asked Questions (FAQs) JUST UPDATED!!!  Review the newly updated January 6, 2020!!!
The additional Q&As are in RED.
New and inproved:

Pre-Claim Review Start of Care/Early Period Checklist

Pre-Claim Review Late Period Checklist 
Next OCHCH Weekly RCD Conference Call - 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
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 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.
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.
Important Information for all HHA in Review Choice Demonstration under PDGM, NAHC Report, January 2, 2020 – For those home health agencies (HHAs) that are part of the Review Choice Demonstration and have selected the Pre-claim Review (PCR) option, the long awaited CMS update confirming that HHAs will need to submit a PCR for each 30-day billing period has been posted. Make sure you review the updated RCD Operational Guide, Chapter 6.


The First 2020 Weekly PDGM Conference Call is today,  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. 

Home Health Reminder and CMS Update to PDGM Split Implementation Instructions, NAHC Report, January 3, 2020 REMINDER: Home Health RAPs Hold – Medicare Administrative Contractors (MACs) typically hold claims for a brief period each quarter when they implement system releases. This January, home health Requests for Anticipated Payment (RAPs) are affected by implementation of the Home Health Patient-Driven Groupings Model. MACs will hold RAPs with From Dates on or after January 1, 2020, and process them once the updates are complete.

INSTRUCTIONS: Change Request 11081 Home Health (HH) Patient-Driven Groupings Model (PDGM) -Split Implementation – On December 20, 2019 Transmittal 4482/Change Request (CR) 11081 was posted, replacing Transmittal 4244 from February 15, 2019. This new CR adds FISS as a responsible party to business requirement 11081.5.1 and adds a requirement and updates attachment 3 to facilitate handling claims with no matching assessment. Also, manual sections are updated to reflect changes made by subsequent transmittals for CRs 11272, 11527 and 11536. All other information remains the same. There is more detailed information in this CR to guide home health agencies in handling various claim situations under PDGM.


Our Take

“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. 
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 HEATLH: Medicare Beneficiary Identifier (MBI)
Question: Now all claims sent after January 1, 2020 must have the MBI on them no matter when the services were rendered. Does the SOC OASIS have to be pulled back, corrected with new MBI and re-transmitted before the claims will be paid?
Answer: The short answer is NO. Melinda Gaboury from Healthcare Provider Solutions, Inc. stated in a listserv response, “We validated with CMS that if the Start date of the episode was before 1/1/2020 the RAP and FINAL could be processed with the HICN….if the episode begins 1/1/2020 or later it will have to be the MBI.”



Regulatory & Policy Digest


HOSPICE: Important Updates on the Hospice Quality Reporting Program (HQRP), CMS Hospice Quality Reporting Program, December 19, 2019 – Swingtech sends informational messages to hospices related to the Quality Reporting Program (QRP) on a quarterly basis. Their latest outreach communication can be found on the HQRP Requirements and Best Practices webpage. If you want to receive Swingtech’s quarterly emails, then add or update the email addresses to which these messages are sent by sending an email to QRPHelp@swingtech.com. Be sure to include your facility name and CMS Certification Number (CCN) along with any requested updates.
HOSPICE: Frequently Asked Questions on the Hospice Outcomes & Patient Evaluation (HOPE) and “HOPE Fundamentals” Available, CMS Hospice Quality Reporting Program, Decmeber 17, 2019 – CMS has posted two documents that articulate key information about efforts to develop a new patient assessment tool for hospice to be proposed in future rulemaking. The Frequently Asked Questions (FAQ) document responds to common questions about patient assessment tools and the HOPE. The other document, called “HOPE Fundamentals,” highlights differences between the Hospice Item Set (HIS) and what CMS currently expects of the HOPE. These documents are now available in the Downloads section of the HOPE page.
HOSPICE: Recruitment Announcement – Alpha Test for the Hospice Outcomes & Patient Evaluation (HOPE) Assessment Instrument, CMS Hospice Quality Reporting Program, December 17, 2019 – Abt Associates is currently recruiting hospice providers to participate in a field test (called an alpha test) of the new hospice patient assessment instrument, titled Hospice Outcomes & Patient Evaluation (HOPE). Data collection is anticipated to begin in late spring 2020.

HOSPICE: Don’t Forget--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.

HOME HEALTH: NOW AVAILABLE IN CASPER - Preview Reports and Star Rating Preview Reports for the April 2020 Refresh, CMS, December 27, 2019 – Providers can now download the latest Provider Preview Reports and the Quality of Patient Care Star Rating Preview Reports from CASPER. These reports preview data that will be displayed in the Home Health Compare website beginning around April 23, 2020. Providers are encouraged to save a copy of their preview reports for later reference.

Learn more about the Home Health QRP data submission deadlines here and about the Home Health Star Ratings here.

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.

HOME HEALTH and HOSPICE: Improper Payment Rates for Home Health and Hospice Providers Decreased in 2019, NAHC Report, January 2, 2020

HOSPICE and HOME HEALTH: Medical Coverage Database (MCD) Article Updates: Home Health and Hospice , Palmetto GBA – This revision is due to the 2020 Annual CPT/HCPCS Code Update and was effective on January 1, 2020.

HOSPICE and HOME HEALTH: Medicare Beneficiary Identifier (MBI) Lookup Tool, 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 and HOME HEALTH: Paramount to Drop Medicaid in Central, Southeast Regions of Ohio – THE BLADE, January 7, 2020
HOSPICE and PALLIATIVE CARE: Improving Health Literacy Could Boost Access to Hospice, Palliative Care, Hospice News, January 6, 2020
PALLIATIVE CARE: Palliative Care Growth a 2020 Priority, Hospice News, January 6, 2020

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