Bulletin: February 25th, 2020

Feb 25th, 2020



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.
We had our first combined PDGM and RCD WEEKLY CALL on February 21st
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
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: 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 ryan@ochch.org
We need:

  • 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 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.


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.
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.

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.



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


By Beth Foster, RN, BA, CPHQ, CEHCH and

Kathy Royer, RN, BA, MBA, DMin, CHPN, CHPCA, CEHCH


March 18th and 19th 8:00 AM - 5:00 PM EDT

Home Health and Hospice Agencies – Now is the time to register for the upcoming Palmetto GBA Update and Financial Conference. This event gives you a great opportunity to listen to Palmetto GBA representatives and other experts, and to share your concerns and question with them in person. Even though OCHCH staff does everything we can to share your concerns with Palmetto representatives, only you can tell them how your concerns affect your agency and those that you serve!

Major home health agency challenges include both RCD and the implementation of the new payment model, PDGM, in which the changes and their affects are coming full force right now!
RCD - Make sure you and your team are prepared for the subsequent review choice in May. All agencies will be required to make their RCD choice again during this time. Attendance at this conference and the Palmetto GBA RCD breakout session will insure you have all the details you need to make the best choice for your agency.
PDGM - As the roll out of PDGM continues to unfold, make sure you are up to date will the changes in cash flow, cost reporting, and more.
Hospice providers will benefit from Palmetto regulatory updates which include industry trends, top medical record review denials, TPE update and what providers need to know for 2020. In addition a breakout session on Hospice billing will be offered.

Click Here  for Full Conference Details
Click Here to Register

Palmetto Update Sessions:
9:00am – 12:45pm – Palmetto GBA Home Health 2020 Updates
1:30pm – 5:00pm – Palmetto GBA Hospice 2020 Updates
Breakout Sessions – These sessions will be taking place simultaneous to the Palmetto 2020 Updates sessions both days
9:00am – 10:30am -Session 1 -
Hospice Billing Updates for 2020-  Presented by Melinda Gaboury
10:45am – 12:15pm - Session 2 -
PDGM and RCD Financial Impacts – Presented by Melinda Gaboury
1:15pm – 3:15pm - Session 3 -
Palmetto GBA RCD Workshop - presented by Dan George (Palmetto GBA)
3:30pm – 5:00pm Session 4 -
OHCN– Presented by Joe Russell (Day 1)
3:30pm – 5:00pm Session 4 -
Home Health Cost Reporting – Presented by Dave Macke (Day 2)
Both days will have the same agenda allowing you to choose which topics you would like to attend with your 1 or 2 day attendance pass. 


Beth Foster, RN, BA, CPHQ, CEHCH and Kathy Royer, RN, BA, MBA, DMin, CHPN, CHPCA, CEHCH


HelpDesk Question of the Week


HOSPICE: Site of Service Codes

Question: What Q code (site of service code) should be used for the Hospice patient who lives in the Skilled Nursing Facility?
Answer: Q5004 shall be used for hospice patients in a skilled nursing facility (SNF), or hospice patients in the SNF portion of a dually-certified nursing facility. There are 4 situations where this would occur:
  • If the beneficiary is receiving hospice care in a solely-certified SNF.
  • If the beneficiary is receiving general inpatient care in the SNF.
  • If the beneficiary is in a SNF receiving SNF care under the Medicare SNF benefit for a condition unrelated to the terminal illness and related conditions, and is receiving hospice routine home care; this is uncommon.
  • If the beneficiary is receiving inpatient respite care in a SNF.

If a beneficiary is in a nursing facility but doesn’t meet the criteria above for Q5004, the site shall be coded as Q5003, for a long term care nursing facility.



Regulatory & Policy Digest


HOME HEALTH: PDGM in Real Time Webinar SeriesIt is not too late to participate! NAHC is pleased to present a series of six free webinars that address a variety of PDGM-essential topics, combined with an open forum where participants share and gain insights with Home Care & Hospice Financial Managers Association (HHFMA) experts about what is working and not working in the early weeks of PDGM. Register now to receive access to both the live and recorded webinars.
HOME HEALTH and HOSPICE: Palmetto GBA eChat-- Palmetto GBA has Secure eChat to make asking Medicare questions easier. This innovative feature allows providers to interact with designated Palmetto GBA staff so they can receive real-time assistance locating information on any topics or specialties they are searching for on the Palmetto GBA website or within the eServices online portal. The Secure eChat feature also allows users to dialogue with an online operator who can assist with patient or provider specific inquires or address questions that require the sharing of PHI information! Using Secure eChat is simple! This free portal is available to all Medicare providers as long as you have a signed Electronic Data Interchange (EDI) Enrollment Agreement on file with Palmetto GBA. Once in the eServices portal, from the bottom right corner select either Medicare Inquiries or eServices Help. If you do not have an eServices account, you can get started by clicking the eServices link.    
HOME HEALTH: CMS Adds Home Health Quality Reporting Program Training, NAHC Report, February 20, 2020 – CMS is offering a quick web-based training to walk providers through upcoming changes to the Quality Reporting Programs (QRPs) for Home Health and three other post-acute care settings along with an overview of existing and upcoming training activities designed to support providers in successfully complying with associated reporting requirements.
HOME HEALTH and HOSPICE: Medical Review Intent to Reopen Process for Non-Receipt of Medical Record Denials, Palmetto GBA – Palmetto GBA's Medical Review department will reopen claims denied for non-receipt of requested medical records and will make a medical review determination on the lines previously denied if the requested documentation is received within 120 days of the claim's Remittance Advice date of denial for non-receipt. Please review this information and share it with your staff.
HOME HEALTH and HOSPICE: Would you like to know if your Medicare patient has a current Home Health or Hospice benefit period?, Palmetto GBA 

HOME HEALTH and HOSPICE: eServices User ManualPalmetto GBA 

HOME HEALTH and HOSPICE: March 2020 JM Home Health and Hospice Medicare Advisory, Palmetto GBA 

HOME HEALTH and HOSPICE: January 2020 Integrated Outpatient Code Editor (I/OCE) Specifications Version 21.0, 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

Hospice: VITAS Focused on Hospice De Novo, Same-Store Growth Over Acquisitions in 2020, Hospice News, February 24, 2020

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