Bulletin: March 3rd, 2020

March 3rd, 2020



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:
  • 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 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.
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.

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
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 –                                                                                                                  

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 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.
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 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.


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

ODH Health Alert - Updated CDC Criteria to Guide Evaluation of Persons Under Investigation for COVID-19, ODH, February 28, 2020 – The Centers for Disease Control and Prevention has updated its "Criteria to Guide Evaluation of Persons Under Investigation for COVID-19.” The Ohio Department of Health (ODH) sent the updated health alert on February 28, 2020 to local health departments and health care providers who participate in the Ohio Health Alert Network regarding this update. OCHCH was asked to share this alert with our provider members. Meanwhile, you can find more information about COVID-19, resources, and the latest developments on ODH’s website at www.coronavirus.ohio.gov.
On February 27, 2020, CDC updated the "Criteria to Guide Evaluation of Persons Under Investigation (PUI) for COVID-19.” This updated guidance is available on the CDC website along with the COVID-19 PUI form.
The ODH Health Alert stated, “The potential public health threat posed by COVID-19 is high, both globally and to the U.S. However, at this time, the risk to the general American public is low. ODH is actively working with local health departments (LHDs) and healthcare providers to effectively identify suspected cases of COVID-19 and continue infectious disease surveillance, prevention, and control.”
Since facilities (aka home health and hospice agencies) are expected to develop and maintain an emergency preparedness plan that is based on the facility‐based and community‐based risk assessment using an “all‐ hazards” approach, Kathy and I recommend that agencies pull out your emergency preparedness plan and review your approach with your staff. It would not surprise us if an ODH surveyor asks your staff, “What are you doing to protect yourself and patients from COVID-19.”



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


HelpDesk Question of the Week


HOME HEALTH: Review Choice Demonstration (RCD) – PreClaim Review (PCR)

Question: When submitting a PCR how do I know what documents need to go into the “task” box?
Answer: Palmetto was created a two job aids to assist home health providers submitting for Pre-Claim Review (PCR) during the Review Choice Demonstration (RCD) to ensure all necessary documentation is submitted to Palmetto GBA.
They are: Pre-Claim Review Start of Care/Early Period Checklist

            Pre-Claim Review Late Period Checklist

These checklist are also located in OCHCH’s RCD TOOLKIT.



Regulatory & Policy Digest


HOME HEALTH, PALLIATIVE CARE and HOSPICE: Senate Unanimously Passes Bill to Provide Respite Care, NAHC Report, February 26, 2020 The United States Senate has unanimously passed the bipartisan Lifespan Respite Care Reauthorization Act of 2019, which would authorize $10 million annually for the Lifespan Respite Care program from fiscal year 2020 through fiscal year 2024. Now this bill will have to be reconciled with the House-passed bill or go directly to the House floor for final passage.
The Lifespan Respite Care Program, though competitive grants to states to establish or enhance statewide Lifespan Respite systems, work to maximize existing resources and help ensure that quality respite is available and accessible to all family caregivers. With more than half of care recipients under age 75 and more than one-third under age 50, Lifespan Respite rightly recognizes caregiving as a lifespan issue and serves families regardless of age or disability.

HOME HEALTH and HOSPICE: COVID-19: New ICD-10-CM Code and Interim Coding Guidance, CMS MLN Matters, February 27, 2020 – The Centers for Disease Control and Prevention’s National Center for Health Statistics will implement a new ICD-10-CM diagnosis code for the 2019 Novel Coronavirus (COVID-19), effective with the next update on October 1. See the announcement and interim coding guidance for more information.

HOSPICE: Hospices Strategize to Stave Off Cap Overage Payments, Hospice News, February 26, 2020 – Careful management of resources can healp hospices avoid the need to repay Medicare for revenues that exceed the payment cap.

HOME HEALTH: PDGM in Real Time Webinar Series – It 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: eServices Profile Verification Timeframes, Palmetto GBA – eServices Profile Verification has been extended from 90 to 250 days, allowing more time for you to complete this process. During this time, please make sure that all eServices user ID profiles are up to date to avoid interruption or deactivation.

HOME HEALTH and HOSPICE: eTicket Enables Providers to Save Time with Every Call, Palmetto GBA 

HOME HEALTH and HOSPICE: Appeal Levels and Timely Filing Limits: Helpful Information, Palmetto GBA

HOME HEALTH and HOSPICE: April 2020 Quarterly Release Temporary Hold, Palmetto GBA 

HOME HEALTH and HOSPICE: Remittance Advice Remark Code (RARC), Claims Adjustment Reason Code (CARC), Medicare Remit Easy Print (MREP) and PC Print Update, 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 and PALLIATIVE CARE: Hospices Can Build Financially Sustainable Palliative Care Programs, Hospice News, February 28, 2020
HOSPICE and PALLIATIVE CARE: Primary Care First Direct Contracting: Where Hospice Fits, Hospice News, March 2, 2020
HOSPICE: Nearly 20% of Unpaid Caregivers in Poor Health, Hospice News, March 2, 2020

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