HOME HEALTH and HOSPICE: UPDATED Weekly ODH Request for Information COVID-19 - Please respond! – The Ohio Department of Health (ODH) is continuing with a second 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 March 5, 2020! This may be an on-going request during the COVID-19 outbreak. If you have not completed the survey please do so ASAP!!!
HOME HEALTH and HOSPICE: CMS Open Door Forum: Updates on BFCC-QIO Appeals Delays, Hospice and Home Health Updates, NAHC Report, February 28, 2020 – On February 26, the Centers for Medicare & Medicaid Services (CMS) held its monthly Home Health, Hospice and DME Open Door Forum (ODF). The following is the list of updates related to hospice and home health organizations:
HOSPICE and PALLIATIVE CARE: CMS Outlines Planned Payment for Hospice Medical Advantage Coverage under VBID Test, NAHC Report, February 28, 2020 – In CY2021 the Centers for Medicare & Medicaid Services (CMS) plans to test coverage of hospice as part of the Medicare Advantage (MA) benefit package through its ongoing Value-Based Insurance Design (VBID) model. A December 2019 Request for Applications (RFA) outlining of the model, participating plans must provide hospice services to eligible beneficiaries, and participating plans must offer palliative care services to non-hospice recipients and transitional concurrent benefits to those enrollees who opt to receive hospice services from an in-network hospice provider.
- BFCC QIO Appeal Delays
- Hospice Quality Reporting Updates
- Home Health PDGM education materials
- Home Health CAHPS
- Home Health PDGM implementation status
- Home Health CAHPS update
- Home Health Quality Reporting Updates
HOSPICE: UPDATE: Webinar for those Interested in Hospice Outcomes & Patient Evaluation Field Test, NAHC Report, February 28, 2020—CMS will present a webinar March 5, 2020 on the Hospice Outcomes and Patient Evaluation (HOPE) tool. The intent of the webinar is to extend a final opportunity for any interested Medicare-certified hospice providers to learn what’s involved in the HOPE alpha test, and if they would like, to indicate interest in participating after the webinar. The Abt Associates team will notify each applicant on or about 4/1/2020 whether they have or have not been selected to participate in the HOPE alpha test
>>>RCD & PDGM Needs–
OPERATION: tackle is OCHCH’s campaign that supports your agency’s PDGM & RCD needs.
NEXT COMBINED - OCHCH WEEKLY PDGM/RCD CALL is FRIDAY, March 6, 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 part of the call will be information on PDGM and Q&As.
The last part of the call 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 –
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 updated March 1, 2020 – 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 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 tommorrw 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 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.