HOME HEALTH and HOSPICE: 16 State Coalition/Palmetto GBA meeting—Joe Russell Executive Director, Beth Foster OCHCH Regulatory Affairs Director and Kathy Royer, OCHCH Hospice Regulatory Director were the only Ohio representatives in attendance at a meeting with Palmetto GBA February 24, 2020. During the meeting the following topics were discussed:
RCD: LUPAs for the 30 day billing period were discussed
Hospice Aggregated Cap Report: Due March 2, 2020
EDI: Providers are reminded to update email addresses in EDI
Hospice Routine Home Care Level of Care: There are still payment issues for RHC transfers
RCD: Discussion was held about if an agency submits the initial PCR and is affirmed and then non-affirmed at resubmission. Education has been provided to Medical Reviewers.
iQIES: there continues to be issues with OASIS submissions which are accepted but then get error message for no matching OASIS
OCHCH along with the other 15 Home Health and Hospice associations continually work with Palmetto GBA on our issues. We will share new/updated Palmetto GBA articles and/or answers as we receive them.
HOME HEALTH and HOSPICE: CMS Open Door Forum, CMS List Serve, February 21, 2020 – The next Home Health, Hospice & DME Open Door Forum is scheduled for Wednesday, February 26, 2020 at 2:00-3:00 PM Eastern Time (ET).
Dial: 1-888-455-1397 & Reference Conference Passcode: 9375124
Persons participating by phone do not need to RSVP.
Please call at least 15 minutes prior to the forum start time.
HOME HEALTH and HOSPICE: COVID-19 Survey Monkey Question – Special Request from ODH! – The Ohio Department of Health (ODH) would like to make a request for information (RFI) in order to maintain a common operating picture on long-term care (LTC) and Non-long term care (NLTC) facilities' Personal Protective Equipment (PPE) needs. ODH recognizes the ongoing COVID-19 outbreak in China may have significant impacts to PPE and other resources in Ohio. ODH requests that you complete the survey monkey in order to support a common operating picture statewide on existing needs or notices of allocation.
Please complete the survey monkey by February 27, 2020. This may be an on-going request during the COVID-19 outbreak.
HOME HEALTH and HOSPICE: CMS Develops New Code for Coronavirus Lab Test, CMS MLN Connects, February 20, 2020 – On February 13, CMS took further action to ensure America’s health care facilities and clinical laboratories are prepared to respond to the threat of the 2019-Novel Coronavirus (COVID-19). Specifically, CMS developed a new HCPCS code for providers and laboratories to test patients for SARS-CoV-2.
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 ***
>>>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.
THIS MEANS: NO MORE CALLS ON TUESDAYS!
We had our first combined PDGM and RCD WEEKLY CALL on February 21st!
NEXT COMBINED - OCHCH WEEKLY PDGM/RCD CALL is FRIDAY, February 28, 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.
The first 30 minutes will be a presentation on “Therapy and PDGM” by Mike Carr 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 –
NEW: RCD – PCR/PostPayment Review Small Group Consultations Scheduled for:
Monday, March 2, from 3p-4p, and Tuesday, March 3, from 10a-11a
The RCD-PCR/Postpayment Review Small Group Consultations are for Home Health Agencies that have less than a 90% Affirmation rate, or have less than a 90% claims approval rate. The OCHCH team would like to increase your scores by having a few volunteer members present their processes and best practices when submitting the PCR request, and Additional Documentation Requests (ADRs). There will be plenty of time for questions and answers. This will all be done by a conference call that will be no more than an hour long.
We can accommodate up to 15 Home Health Agencies at a time, but your agency may have many staff present. This means one call in but as many of your staff present as you want. This is first come, first serve for registration.
Registration will be completed by one designated person from your agency e-mailing Ryan Crawford firstname.lastname@example.org
Your HHA’s NAME, and the name and e-mail of the designated representative for your agency.
Choose your Date for the Small Group Consultations
The designated representative is responsible for sharing the call in number with their staff. The call in number will be given to you after you register.
FYI - How to Retrieve Your RCD Affirmation Rate and Claims Approval 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.
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.
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 email@example.com 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.
Unique Tracking Number (UTN) Location on the Final Claim, Palmetto GBA – This job aid instructs providers on where to enter the 14 digit alpha-numeric unique tracking number (UTN) provided in the PCR notification on the final claim for Electronic claims, Data Entry or the UB04 Claim Form. Please share with appropriate staff.
>>> 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 firstname.lastname@example.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.