Bulletin: February 4th, 2020

Feb 4th, 2020



HOME HEALTH: Information about the EVV Provider Hotline, ODM – As you know, the EWCC Provider Hotline is a resource for technical assistance and to troubleshoot issues with the Sandata solution. In a recent review of calls to the EVV Provider Hotline, we learned that some agency providers were asking their providers to call the hotline for a trouble ticket for things like forgetting to log in or requesting call in/call out times for timesheets. This is a relatively high volume call type and is an area where calls are increasing. In an effort to make sure that the hotline is available for providers who need technical assistance, we are asking associations to share this information with your members.

HOSPICE: Hospice Care: Safeguards for Medicare Patients, CMS MLN Matters, January 30, 2020--In a two-part report series, the Office of Inspector General (OIG) focused on hospice:

  • Quality of care and common deficiencies
  • Instances of beneficiary harm and vulnerabilities
CMS released the Safeguards for Medicare Patients in Hospice Care (PDF) Fact Sheet to help you recognize and address deficiencies in care and protect your patients from harm. Additional resources:  
HOSPICE: Work Advancing on CMS Hospice Outcomes & Patient Evaluation Tool, Hospice News, January 29, 2020--The U.S. Centers for Medicare & Medicaid Services (CMS) is currently recruiting hospice providers to participate in a pilot test of the forthcoming Hospice Outcomes & Patient Evaluation (HOPE) tool, which when completed will replace the Hospice Item Set (HIS) quality reporting system. 

HOME HEALTH: Latest Home Health Compare Quarterly Refresh Now Available, NAHC Report, January 28, 2020 – The January 2020 quarterly Home Health Compare refresh is now available on the Home Health Compare website. Please visit to view the new and updated quality data.

As of this new refresh, the Centers for Medicare & Medicaid Services (CMS) is no longer publicly reporting two clams-based measures: Emergency Department Use without Hospital Readmission during the First 30 Days of HH (NQF #2505) and Rehospitalization during the First 30 Days of Home Health (NQF #2380).

HOME HEALTH: CMS Issues iQIES Log to Assist Providers, NAHC Report, January 31, 2020 – CMS has released an Internet Quality Improvement and Evaluation System (iQIES) issues log to assist providers and other stakeholders in knowing what processing issues exist and the status of resolution. CMS agreed to develop the log at the request of stakeholders when providers began experiencing multiple problems with OASIS submission through the iQIES in the January transition.

HOME HEALTH: REMINDER: iQIES Issues Still Occurring – Along with reporting to NAHC you may 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 OCHCH informed of any issues with iQIES. The OCHCH Regulatory Department (Kathy Royer and Beth Foster) are ready to assist you! PLEASE contact OCHCH by using helpdesk@ochch.org and use subject title, iQIES.

>>>RCD UPDATES –                                                                                                                  

Next OCHCH Weekly RCD Conference Call - Friday, February 7, 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 for 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 months of November, December, and January 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 is February 5, 2020.
Quarterly Review Choice Demonstration (RCD) Medical Review Teleconference Schedule – Next date is March 11, 2020.

How to Retrieve Your RCD Affirmation RateCLICK HERE 
eRCD is Now Active - eRCD is a new feature on the Provider Dashboard within eServices that provides you with the ability to monitor your Review Choice Demonstration (RCD) results. You will enjoy features such as your RCD affirmation or claim approval rate, and current Additional Documentation Request (ADR) and Pre-Claim Review (PCR) decisions.


OCHCH Weekly PDGM Conference Call is today, Tuesday, February 4, 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.
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 posted to the PDGM TOOLKIT.
Patient-Driven Groupings Model (PDGM) Grouping Tool Help Document link – The purpose of the grouping tool Excel file is to help users understand how the payment grouping parameters, which are part of the PDGM, would be used to determine case-mix assignments that are part of the payment calculation under the Home Health Prospective Payment System (HH PPS).  

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.

Our Take

A New Era in Managed Care for Health Care at Home

By Joe Russell, Executive Director
OCHCH is engaged in a full-scale effort to get our member agencies better reimbursement rates and better regulations. One of the more pressing issues with this focus has been around managed care.
Over the past three years OCHCH has attempted to address member concerns with the Ohio Department of Medicaid (ODM), the Ohio General Assembly, and even the health plans themselves, but issues with managed care continue to be pervasive.
Well we’ve had enough. We’ve had enough with the plans kicking our members around. We’ve had enough with pre-auths. We’ve had enough with NOT getting paid. The list goes on and on. Subsequently we’re no longer going to wait for others to act. We are placing the future into our own hands.
I’m so very excited to announce the creation of the OCHCH managed care network, called the Ohio Community at Home Network (OCHN), aimed at resolving your agency’s managed care issues.
OCHN will serve as a sibling organization to OCHCH, but will focus exclusively on managed care topics for those OCHCH members that decide to join OCHN. OCHCH will still engage on a variety of managed care issues including government advocacy, while OCHN will get more into the nitty-gritty of managed care such as negotiating reimbursement and contract terms, and resolving contract issues among other things.
I’ll be traveling around the state throughout the month of February to explain how the network will operate and allow home health and hospice agencies the opportunity to join the network ahead of the official March launch. The hope is that OCHN can begin offering the network to Medicaid Managed Care Plans (MCPs), Medicare Advantage, and commercial managed care plans shortly after the March launch. 
We’re so excited for OCHN! A ton of hard-work has gone into its creation, which marks a new era in managed care for health care at home agencies.
Please join us at one of the upcoming FREE informational events that are open to all OCHCH members in good standing. Click here for the locations, dates, and to register! See you soon!

Executive Director of OCHCH, Joe Russell


HelpDesk Question of the Week



Listserv Question: Are any other home care providers having issues with Medicaid denying claims with the message "RECIPIENT HAS OTHER INSURANCE COVERAGE ON THE MEDICAID THIRD PARTY LIABILITY FI" on claims that were being paid in the past with "TPL ON RECIPIENT FILE, NOT ON CLAIM (PAY CLAIM)" when entered directly in OHMITS?
This is now an issue for us with patients that have Third-party Liability coverage with Third-party Payers that we had billed in the past, received EOB on the denials, and attached them to claims we then submitted to Medicaid over a year ago. From that point on, the claims would pay with the "TPL ON RECIPIENT FILE [..]" response.
However, around the end of 2019, these claims stopped paying despite the fact there are not any changes in their respective third party coverage. We were given conflicting information (from both Provider Assistance and noninstitutional_policy@medicaid.ohio.gov) that there was a known system error, on the one hand, and that our provider type requires *current* TPL information attached to *every* claim, on the other hand, which was not the case in the past.
Answer from Connie Fox from ACMC Regional Home Health: Have you entered the TPL information on the denied claims into MITS? If not, more than likely that is why you are not getting paid.
Connie sent OCHCH the MEDICAID TPL INSTRUCTIONS she wrote up for her staff on how to enter it into MITS as it is several steps longs. On behalf the OCHCH members – Thank you Connie!!!



Regulatory & Policy Digest


HOME HEALTH and HOSPICE: Trump Administration Proposes Medicaid Block Grants, Strategic Healthcare – CMS has announced the agency's anticipated Medicaid block grant demonstration titled the "Healthy Adult Opportunity", details of which appear in a 56-page CMS letter to state Medicaid directors. The HAO is available to all states and will be initially approved for five years and may be renewed for up to 10 years. Demo participants can include adults under age 65 that are not eligible for Medicaid based on disability or a need for long term care and are not eligible under a state plan. States may target a defined subset of high need individuals for HAO demonstration participation and states can migrate Medicaid enrollees from current 1115 waiver demonstrations to the HAO demonstration. Critics say this initiative will do the opposite of what it promises, by limiting opportunities for people to sign up for Medicaid and drastically cutting the threshold of eligibility for Medicaid. However, some states are already jumping on the chance for the demo with Oklahoma's Governor announcing that they will now expand Medicaid under the new formula. For the letter, click here, and for the factsheet, click here. For Administrator Verma's remarks on the plan, click here.
  • House Democratic leaders announced they will vote on a resolution of disapproval of the proposed demonstration this week, click here.

HOME HEALTH and HOSPICE: Update to the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) for Vaping Related Disorder, CMS MLN Connects, January 30, 2020--A new MLN Matters Article MM11623 on Update to the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) for Vaping Related Disorder (PDF) is available. Learn about the addition of a new code effective April 1.

HOSPICE: Medicare Care Choices Model (MCCM) Frequently Asked Questions, Palmetto GBA, January 29, 2020--This article provides answers to Medicare Care Choices Model (MCCM) frequently asked questions. Please share with appropriate staff.
HOSPICE: Accessing Hospice PEPPER Reports Can Help Avoid Audits, Hospice News, February 3, 2020--Hospices who understand and consider their Program for Evaluating Payment Patterns Electronic Reports (PEPPER) from their Medicare Administrative Contractor (MAC) can leverage that information to anticipate and correct payment issues that could lead to targeted probe and education (TPE) audits if left unaddressed.

HOME HEALTH: CMMI Releases Second Annual Report on Home Health Value Based Purchasing, NAHC Report, January 28, 2020 – The Centers for Medicare and Medicaid Innovations (CMMI) has issued the second annual report on the Home Health Value Based Purchasing (HHVBP) program. The report reflects the performance of participating agencies and non- participating agencies (as a comparison group) for calendar years 2016 and 2017.

HOSPICE and HOME HEALTH: Hospice and Home Health Claims Processing Issues Log, Palmetto 

Upcoming Education & Events


For Upcoming webinars, conferences, workshops and events click HERE

Click image to find out more!

News Clips & Links

HOSPICE and HOME HEALTH: Ohio Medicaid Launches Program to Improve Child Health and Wellness,The Hannah Report on January 23, 2020 – ODM announced Thursday that it will be releasing the first payment for its new Comprehensive Primary Care (CPC) for Kids Program, which has been launched to measurably improve child health and wellness across the state.
HOSPICE: Population Health Models Can Help Hospices Admit Patients Earlier, Hospice News, January 29, 2020
HOSPICE: Hospice Saw Largest 2019 M&A Deals in Care-at-Home Sector, Hospice News, February 3, 2020
HOSPICE: Hospice Provider Care Dimensions Launches Learning Institute, Hospice News, February 3, 2020
HOME HEALTH and Hospice: Demand for Direct Care Workers Far Outstrips Supply, NAHC Report, January 30, 2020

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