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SNAP SHOT
HOSPICE: Reminder—the Provider Self-Determined Aggregate Cap Limitation form is due March 2, 2020
- Please click on the link below for updated instructions for the self-calculation and submission of the CAP.
- The form is required of hospital-based and freestanding hospices for whom Palmetto GBA processes claims
- If the form is not received timely, a past due letter will be issued and payments will be suspended
*** File soon so payments will not be suspended ***
HOSPICE: Hospice Licensure Rules Have Been Updated. Effective January 23, 2020—The following Hospice licensure rules have been updated. In general the changes impact the role of the Medical Director, inspection definitions and the Palliative Care patient admitted to the Hospice in patient unit.
3701-19-01 Definitions
3701-19-03 Initial license application process; renewal of license; and change of ownership license
3701-19-04 Issuance, denial, transfer, suspension, and revocation of licenses
3701-19-06 Governing body; quality assessment and performance improvement
3701-19-09 General requirements for hospice care program personnel
3701-19-10 Medical director
3701-19-11 Interdisciplinary team and interdisciplinary plan of care
3701-19-16 Home care services
3701-19-18 Counseling and bereavement services
3701-19-20 Admission of patients to the hospice care program
3701-19-22.1 Admission of non-hospice palliative care patients to hospice inpatient facilities
3701-19-23 Central clinical record
HOME HEALTH and HOSPICE: VA/Optum Referral Issue, Forum of States Discussion List January 9, 2020 , From Calvin McDaniels Directr of Government Affairs, NAHC--“We’ve recently received several reports of providers not being able receive referrals for VA patients with the recent transition from TriWest to Optum as the third part administrator for the VHA. Additional details here. NAHC has been in touch with the congressional committees overseeing this transition. They have asked for additional cases and examples of this occurring where veterans are not receiving necessary care. Please reply directly to me (cmcdaniel@nahc.org) if you have experienced this.
HOME HEALTH: CMS Open Door Forum Summary: Updates on iQIES Transition and Home Health, NAHC Report, January 10, 2020 – CMS held a Home Health Open Door Forum (ODF) on January 8, 2020. This is list of the topics: iQIES Transition, PDGM Update, Home Health Quality Reporting Program, and Review Choice Demonstration (RCD).
HOME HEALTH: REMINDER: iQIES Issues Still Occurring – Call Keith Weaver, Ohio Dept. of Health Automation specialist, 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 Beth Foster informed of any issues with iQIES. The OCHCH Regulatory Department (Kathy Royer and Foster) are ready to assist you! PLEASE contact OCHCH by using helpdesk@ochch.org and use subject title, “iQIES.”
HOSPICE: CMS Open Door Forum Summary, NAHC Report, January 10, 2020—CMS held a Hospice Open Door Forum on January 8, 2020. Topics covered include Hospice Benefit Component of the Value Based Insurance Design (VBID) Model and the Hospice Quality Reporting Program.
HOME HEALTH and HOSPICE: MAC Listening Sessions – Your Opportunity to Provide Feedback, NAHC Report, January 7, 2020 – CMS is holding listening sessions to gather feedback and improve experience with the Medicare Fee-For-Service (FFS) program. This is your opportunity to provide feedback on your MAC – Medicare Administrative Contractor. For home health and hospice there are three MACs: Palmetto GBA, CGS, and NGS.
>>>RCD UPDATES –
RCD UPDATES –
OPERATION: tackle RCD – THE OCHCH CAMPAIGN TO SUPPORT YOUR AGENCY’S RCD NEEDS IS READY FOR THE NEW YEAR
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 improved:
Pre-Claim Review Start of Care/Early Period Checklist
Pre-Claim Review Late Period Checklist
PCR Resubmissions, Palmetto GBA – When utilizing the PCR resubmission process, most of the fields are editable. There are however, a few fields that must match the initial request in order to determine if the resubmission is a true resubmission or if the request is for a different beneficiary, HHA, and/or period of time. Please review and share with your staff.
Next OCHCH Weekly RCD Conference Call - Friday, JANUARY 17, 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 and January are available in the RCD Toolkit.
DO YOU HAVE A RCD QUESTION FOR PALMETTO GBA?
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.
Monthly Review Choice Demonstration (RCD) Provider Teleconference Schedule – Next date is February 5, 2020.
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.
>>> PDGM UPDATES –
OPERATION: tackle PDGM – THE OCHCH CAMPAIGN TO SUPPORT YOUR AGENCY’S PDGM NEEDS IS READY FOR THE NEW YEAR
OCHCH Weekly PDGM Conference Call is today, Tuesday, January 14, 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.
The links to the PDGM Call Recordings for the month of December and January are available in the PDGM TOOLKIT.
The Home Health FAQs - Home Health Patient-Driven Groupings Model (PDGM) – (January 6th, 2020- link) was just posted to the PDGM TOOLKIT.
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. (FYI - CMS needs to corrected the RAP percentage to state 20%/80%.)
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