Bulletin: January 21st, 2020

January 21st, 2020

   
 

SNAP SHOT

HOSPICE: Hospice Coalition Questions and Answers, Palmetto GBA List Serve, January 17, 2020--
The October 3, 2019, Hospice Coalition Questions and Answers are now available. Please review and share this information with your staff.
 
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: 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.
 
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 –                                                                                                                  

OPERATION: tackle RCDTHE 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 

Next OCHCH Weekly RCD Conference Call - Friday, JANUARY 24, 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 months of November, 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.

RCD Q&A Clarification – SOC or Recert Occurs prior to January 1, 2020 - HHA Receives 60 Day Episodic Payment
Example: Submit a SOC or recert with a certification period of 11/29/19 – 1/27/20
 
If the recert is not due until within last 5 days of the 1/27/2020 end of cert date, you will be reimbursed under the 60 day episodic payment.
 
Under RCD you should have received a UTN after the SOC or Recert in Nov. 2019.
 
However, under RCD you still need to submit a PCR for the second 30 days of the 60 day episode and you should receive a UTN. This UTN will not be used for the 60 day episodic payment.
 
Only 1- 60 day UTN is required for all episodes that begin prior to 1/1/2020 (even if they cross over into 2020). The 30 day UTN’s are only needed for episodes with start dates 1/1/2020 and after and that.
 
OCHCH confirmed with Palmetto that the UTN received prior to Jan. 1, 2020 for a SOC or recert is the UTN to bill the 60 day episodic payment. If there are at least 30 days left in the 60 day episode, you would still need to request a PCR but would not use the UTN from the 2nd 30 days because the HHA will be reimbursed under the 60 day episodic payment. After that payment it will be the PDGM 30 day payment periods.
 
Is it understood that with the changeover to PDGM, any patients submitted after 1/1/20 will need to be broke out into the (2) 30 day billing period- even if the cert period in question started prior to 1/1/20.
 

>>> 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 21, 2020 at 3pm.
Next week it will be on Tuesday, January 28, 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. 
 
UPDATED INFO: CMS Updates Claims Processing Manual, NAHC Report, January 14, 2020 – CMS has again updated Change Request (CR) 11081 – Home Health (HH) Patient-Driven Groupings Model (PDGM) – Split Implementation through Transmittal 4489. This CR has been updated more than once since its original publication in early 2019. This most recent update corrects the Request for Anticipated Payment (RAP) payment percentage in the Policy section of the Business Requirement form. The correction was necessary because the previous release did not update the RAP percentages with the 2020 Home Health final rule update effective January 1, 2020 which reduced the RAP percentage to 20 percent. All other information remains the same.
 

UPDATED INFO: Home Health (HH) Patient-Driven Groupings Model (PDGM) - Spilt Implementation, Palmetto GBA  - Change Request (CR) 11081 effectuates the policies of the Patient-Driven Groupings Model (PDGM) as described in the November 2018 home health (HH) final rule. CMS revised the article on January 14, 2020, to reflect a revised CR11081 that CMS issued on January 9. CMS revised the CR to correct the RAP payment percentage in the Policy section of the Business Requirement form in the CR. CMS revised the article to reflect the same change in the Background Section of the article. Please make sure your billing staff is aware of these changes.

Our Take

Managed Care

By Alexandra Weingarth, Policy and Advocacy Director

One of OCHCH’S main priorities is to alleviate burden surrounding managed care. While we know that the re-procurement process is approaching, we do not want to wait for our issues to be resolved at an unidentified timeline. Therefore, we have suggested regular meetings between provider associations, the Ohio Department of Medicaid, and the plans. Last week was our first meeting with the ODM where we asked them to provide their interpretations of certain statutes, and what authority the managed care plans may or may not have regarding ODM’s interpretations. Internally, we have been collecting data and case information from our members to provide examples to the Department.

This will be an ongoing process, so if you have any additional information that you would like us to include in our conversations, please email alex@ochch.org. Additionally, ODM will be taking a close look at the home health “claims portal.” They have asked to urge providers to submit a claim if there is an issue regarding managed care. This is important because they collect data from those claims to track trends in the managed care plans.

Once ODM sends us their interpretation of managed care rules and statute we will share it with you. We want our members to be well educated on these provisions and let us know if a managed care plan is incorrectly interpreting a statue. We are excited to diligently work on these issues and are always advocating your interests. If you have any additional questions or concerns about this process please reach out to the Policy and Advocacy Director, Alex Weingarth at alex@ochch.org.


Alexandra Weingarth

HelpDesk Question of the Week

 
 

HOME HEALTH:  RCD Claim Approval Rate Calculations

Question: I heard in workshops that under PCR if a non-affirmation is given the provider can resubmit as often as they need to get an affirmation. The attached article does not reflect the same information.
 
Answer: The provider is confusing PCR affirmation rates with Claim approval rates. These are two different items.
  • The article is for claim approval rates for providers that have the postpayment claim reviews via the ADR process (post pay, spot check, etc.), not PCR. The article is correct.
  • PCR affirmations are for providers who utilize Pre-Claim Review. It is correct that under PCR, if a non-affirmation is given, the provider can resubmit as often as they need to get an affirmation.
OCHCH requested that the article, RCD Claim Approval Rate Calculations, be updated to make it clear which option the calculations are affecting. This was Palmetto GBA’s response:
  • Please note that a claim approval rate is different than the Pre-Claim Review (PCR) affirmation rate. The claim approval rate is for agencies that selected an RCD ADR option (Post Payment Review, Selective Post Payment Review, Spot Check). The PCR affirmation rate is for agencies that selected the PCR option.

   

   

Regulatory & Policy Digest

 

HOSPICE: Hospice Notice of Transfer (NOTR), Type of Bill (8XC), Palmetto GBA List Serve, January 17, 2020--Palmetto GBA has identified an issue affecting Hospice NOTRs (8XCs), which are returning with reason code U514A when the transfer occurs on the recertification date, day 61 or 91. Hospices cannot complete transfer billing due to the NOTR returning for reason code U514A. Please review this information and share it with your staff.

HOSPICE: MedPAC: No 2021 Pay Raise for Hospice, Calls for Payment Cap Cut, Hospice News, January 20, 2020

HOME HEALTH: Manual Updates Related to Calendar Year (CY) 2020 Home Health Payment Policy Changes, Maintenance Therapy, and Remote Patient Monitoring, Palmetto GBA
 
HOSPICE and HOME HEALTH: eServices Administrators: Assign Unique User IDs, Palmetto GBA
 
HOSPICE and HOME HEALTH: Managing Multiple eService Accounts Is Easier with Account Linking, Palmetto GBA 
 

HOSPICE and HOME HEALTH: eServices Portal Users Must Use Multi-Factor Authentication (MFA), Palmetto GBA 

HOME HEALTH and HOSPICE: Submitting the Credit Balance (838) Report and Due Dates by January 30, 2020. Palmetto GBA
 

HOME HEALTH and HOSPICE: New Medicare Beneficiary Identifier (MBI) Get It, Use It, Palmetto GBA 

HOSPICE and HOME HEALTH: eTicket Enables Providers to Save Time with Every Call , 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

HOME HEALTH: Home Care Dominates the Best Jobs without a College Degree, NAHC Report, January 17, 2020.
 
HOSPICE: Hospices Leverage Machine Learning to Improve Care, Hospice News, January 15, 2020
 
HOSPICE: Hospices Take Note: ACOs Focused on Reducing Hospitalizations, Hospice News, January 15, 2020
 
HOSPICE: Patient Surrogate’s Spiritual Beliefs Impact Hospice Election, Hospice News, January 15, 2020


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