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:
For More Information:
- Influenza virus vaccine once per influenza season
- Additional influenza vaccines if medically necessary
HOSPICE: Important Reminder!!! The Provider Self-Determined Aggregate Cap Limitation form is due March 2, 2020
*** File soon so payments will not be suspended ***
- 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
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.
OPERATION: tackle is OCHCH’s campaign that supports your agency’s PDGM & RCD needs.
>>>RCD & PDGM 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
If you have trouble getting on the Call – PLEASE CALL OCHCH 1-614-885-0434 Ext.206, or e-mail email@example.com
>>>RCD UPDATES –
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 Rate – CLICK 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.
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 firstname.lastname@example.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 email@example.com 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.