Bulletin: February 18th, 2020

Feb 18th, 2020

   
 
SNAP SHOT
HOME HEALTH and HOSPICE: President’s Budget Reinforces Goal of Unified Post-Acute Payment System, Takes Aim at Hospice in Nursing Homes, NAHC Report, February 13, 2020 On Monday, February 10, 2020, a general outline of the President’s fiscal year (FY) 2021 budget was submitted to Congress. The FY2021 budget proposes to reduce spending on programs administered by the Centers for Medicare & Medicaid Services (CMS) by $1.6 trillion over the next 10 years, including $500 billion from Medicare and $920 billion from Medicaid.

HOME HEALTH and HOSPICE: Influenza Activity Continues: Are Your Patients Protected?, CMS MLN CONNECTS, February 13, 2020 – People over 65 are at a greater risk of developing serious complications from seasonal influenza. The Centers for Disease Control and Prevention (CDC) recommends annual influenza vaccination for everyone 6 months and older. As long as influenza viruses are circulating, it is not too late to get vaccinated – to help protect your patients, your staff, and yourself. 
Medicare Part B covers:
  • Influenza virus vaccine once per influenza season
  • Additional influenza vaccines if medically necessary
For More Information:
HOSPICE: Important Reminder!!! The Provider Self-Determined Aggregate Cap Limitation form is due March 2, 2020
  • Please click on the link above 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: Reminder--REGISTRATION OPEN – Hospice Item Set (HIS) Data Submission Requirements Webinar, CMS List Serve, February 6, 2020 – The Centers for Medicare & Medicaid Services (CMS) will be hosting a webinar on Tuesday, March 3, 2020, from 2:00 to 3:30 p.m. ET. The purpose of the webinar is to provide a general overview of the Hospice Item Set (HIS) and associated submission requirements. See the Hospice Quality Reporting Training: Announcements and Registration webpage for details.

HOME HEALTH: What New Home Health Agencies (HHAs) Need to Know About Being Placed in a Provisional Period of Enhanced Oversight, Palmetto GBA – MLN Matters Special Edition Article (SE) 19005 provides important information about the Centers for Medicare & Medicaid Services' (CMS) placement of new HHAs into a provisional period of enhanced oversight. CMS revised this article on February 12, 2020, to provide information on the impact of the final rule with comment CMS-1711-FC and to include a link to that final rule. You and your staff should be aware of these procedures.



>>>RCD & PDGM Needs–                                                                                                          

OPERATION: tackle is OCHCH’s campaign that supports your agency’s PDGM & RCD needs.
 
We have been having WEEKLY RCD CALLS since October 25, 2019, and WEEKLY PDGM CALLS since December 10, 2019. After the PDGM calls started the questions on both weekly calls were a combination of RCD and PDGM questions. The OCHCH team huddled and created a new game plan to merge the CALLS into ONE CALL per week.
 
Starting this week of February 16th OCHCH will have a combined PDGM and RCD WEEKLY CALL!
THIS MEANS: NO MORE CALLS ON TUESDAYS!
 
However, on FRIDAY, February 21, 2020 at 10am OCHCH WEEKLY PDGM/RCD CALLS WILL KICK OFF!!!
 
DON’T MISS THIS OPPORTUNITY!! Please mark your calendars for EVERY FRIDAY @ 10am. The calls will last no more than an hour.
 
The first 30 minutes will be a presentation on “PDGM and RCM” by David Hoover from Axxess.
The last 30 minutes will be spent on RCD updates and Q&As.
 
Call-in info for 2020 will remain the same as all the Friday calls:
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

 

>>>RCD UPDATES –                                                                                                                  

NEW TOOLS:

Pre-Claim Review (PCR) and Low Utilization Payment Adjustments (LUPAs), Palmetto GBA – With the transition to the Home Health Patient-Driven Groupings Model (PDGM), CMS will phase in the inclusion of LUPAs within the Review Choice Demonstration. Please review and share with your staff.


OCHCH is in the final steps of setting up the RCD/PCR Small Group Consultations for HHAs that have less than a 90% Affirmation rate. HHAs that selected the Postpayment Review option may also participate in these groups if they have less than a 90% claims approval rate. The OCHCH team would like to increase your scores!
 
STAY TUNED for more detailed information on the group consultation.
  
FYI - 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.
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, January, and February 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 March 4, 2020.

Quarterly Review Choice Demonstration (RCD) Medical Review Teleconference Schedule – Next date is March 11, 2020.


>>> PDGM UPDATES

NEW TOOLS – MLN Matters Articles:

The Role of Therapy under the Home Health Patient-Driven Groupings Model (PDGM) - This article provides information on the continuing role of therapy under the newly implemented home health prospective payment system (HH PPS) case-mix adjustment methodology, named the Patient-Driven Groupings Model (PDGM), for home health periods of care starting on and after January 1, 2020.

 

A new MLN Matters Article MM11656 on Update to the Home Health Grouper for New Diagnosis Code for Vaping Related Disorder (PDF) is available. Learn about diagnosis code U07.0.

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, January, and February are available in 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

ATTENTION – MUST READ!!!
By Beth Foster, RN, BA, CPHQ, CEHCH
 
Physician’s Signature on the Plan of Care Form
This story started in January – Behind the scene OCHCH’s Regulatory Affairs Director, Beth Foster, has been in discussions with Palmetto off and on since January 10, 2020. Since that time Foster received two calls from Palmetto representatives to discuss with them all the reasons to accept the physician signed POC page.
 
The “straw that broke the camel’s back” occurred during the February 5, 2020 Palmetto GBA RCD Monthly provider call when two different Palmetto staff were presenting conflicting requirements about the physician’s signature on every page or one page of the Plan of Care form, and also not having all pages faxed back from the certifying physician. One Palmetto staff stated, “We do not require that.” Then another stated that “there needs to be a fax thread or a cover sheet to prove that physician read all pages.”
 
I e-mailed a question to the Palmetto staff asking, “Why is this being required, when not even the state survey agencies that have oversight over the Medicare certified HHAs have no such requirement?”
 
To make a long story short OCHCH had input into the updated article titled Responding to a Home Health Additional Documentation Request (ADR). Palmetto GBA has revised an article that was already in their website to include a specific mention to the pagination on the Plan of Care (i.e. page 1 of 4, page 2 of 4, page 3 of 4, and page 4 of 4). There are several other edits made to the article to refresh it as it is an article that Palmetto GBA has had out there for quite some time. Hopefully this article will help with some of the questions HHA providers have sent to Palmetto GBA regarding the physician’s signature on the Plan of Care form.
 
Under the Plan of Care and Certification/Recertification” section the article states:
“If the physician signature is not on every page of the plan of care it must be clear that all pages of the plan of care are associated. For example, each page of the plan of care contains the page number and the total number of pages, such as 'Page 1 of 4,' 'Page 2 of 4,' etc.”
 
Just to make sure, I asked Palmetto the following question: “I want to make sure that the medical reviewers will accept not only the first (or last) page (i.e. page 1 of 4 or it could be page 4 of 4) POC signed/dated by the physician, but also the rest of the POC pages the HHA has in the patient’s medical record.
 
Palmetto GBA representative responded: “Yes, that is correct.”



Beth Foster, RN, BA, CPHQ, CEHCH

 

HelpDesk Question of the Week

 
 

HOME HEALTH: EVV Phase 3

Question: I was in an agency today and they asked me what I thought about Therapy falling under EVV soon. Is there a recent ruling that Therapy will have to do EVV coming up soon?
 
Answer: Yes PT, OT, and Speech will be on EVV beginning Phase 3. Training for Phase 3 will begin in fall of 2020 and Therapy providers will be required to use EVV 01/01/2021. The following information is from the Ohio Department of Medicaid website “EVV Phase 3” power point.  Here is a link to the power point: https://www.medicaid.ohio.gov/Portals/0/Initiatives/EVV/Providers/P3-Overview.pdf
 
Timeline
• 1/8/2018 Phase 1
• 8/5/2019 Phase 2
Fall 2020 Phase 3 provider training will begin » providers may begin using EVV upon completion of training
• 01/01/2021 Phase 3 providers are required to use EVV.
• Edits will post to claims and claims will not be denied until a date TBD.
 
What Services are included in Phase 3?
• Participant Directed Aide Services » MyCare Ohio » ODA » DODD » Ohio Home Care Waiver (once implemented)
• Home Health Therapies » Physical Therapy (G0151) » Occupational Therapy (G0152) » Speech Therapy (G0153)

   

   

Regulatory & Policy Digest

 

HOME HEALTH and HOSPICE: Senators Challenge VA on Backlog of Unpaid Providers, NAHC Report, February 12, 2020 The Department of Veterans Affairs (VA) faced sharp questioning during a Senate committee hearing on February 5 from skeptical Senators about a growing backlog of unpaid providers caring for elderly and disabled veterans.
Senators Challenge VA on Backlog of Unpaid Providers, pdf
 
HOME HEALTH and HOSPICE: New Medicare Beneficiary Identifier (MBI) Get It, Use It, article revised, CMSMLN Matters, February 13, 2020-- CMS revised the article on February 12, 2020, to add a sentence to the MBI look-up tool option for getting an MBI to show what happens if the beneficiary record has a date of death. All other information remains the same.


 

HOME HEALTH and HOSPICE: ePass is Available to Ease the Burden of Repeated Authentication When Calling Palmetto GBA's Provider Contact Center, Palmetto GBA, February 10, 2020

HOME HEALTH: Medicare Home Infusion Benefit January 2021, CHAP AnnouncementCommunity Health Accreditation Partner (CHAP) has submitted their application to CMS for approval as a recognized Accrediting Organization (AO) for Home Infusion Therapy (HIT).
 

HOME HEALTH: 2020 Home Health Data Map for Ohio, Palmetto GBA – The Comprehensive Error Rate Testing (CERT) program looks for improper payments on Medicare claims. Based on the 2020 annual report, Palmetto GBA has released the report data for Ohio home health. Please review and share with your staff.

HOSPICE: 2020 Hospice Data Map for Ohio, Palmetto GBA – The Comprehensive Error Rate Testing (CERT) program looks for improper payments on Medicare claims. Based on the 2020 annual report, Palmetto GBA has released the report data for Ohio. Please review and share with your staff.

HOME HEALTH and HOSPICE: Did you know you can view your latest electronic Comparative Billing Report (eCBR) in eServices?, 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



Click image to find out more!
 

News Clips & Links

HOME HEALTH and HOSPICE: Encompass Health's 2020 M&A Strategy Leans Towards Hospice, Hospice News, February 12, 2020
 
HOSPICE: Hospice Providers: Staffing is Our Top 2020 Challenge, Hospice News, February 12, 2020
 
HOSPICE:  Effective On-boarding Aids Hospice Staff Retention, Hospice News, February 17, 2020
 
HOSPICE: Confessions of a Nurse: Improve Hospice Care in Assisted Living, Skilled Nursing, Hospice News, February 17, 2020


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