Bulletin: March 10th, 2020

SNAP SHOT

HOME HEALTH and HOSPICE: COVID-19 Response: CMS Issues FAQs to Assist Medicare Providers, CMS MLN List Serve, March 9, 2020 – On March 6, CMS issued frequently asked questions and answers (FAQs) for health care providers regarding Medicare payment for laboratory tests and other services related to the 2019-Novel Coronavirus (COVID-19). The agency is receiving questions from providers and created this document to be transparent and share answers to some of the most common questions.

Included in the FAQs is:

• Guidance on how to bill and receive payment for testing patients at risk of COVID-19.

• Details of Medicare’s payment policies for laboratory and diagnostic services, drugs, and vaccines under Medicare Part B, ambulance services, and other medical services delivered by physicians, hospitals, and facilities accepting government resources.

• Information on billing for telehealth or in-home provider services. Since 2019, the Trump Administration has expanded flexibilities for CMS to pay providers for virtual check-ins and other digital communications with patients, which will make it easier for sick patients to stay home and lower the risk of spreading the infection.

 
HOME HEALTH and HOSPICE: CMS Develops Additional Code for Coronavirus Lab Tests,  CMS List Serve, March 5, 2020 – The Centers for Medicare & Medicaid Services (CMS) recently took additional actions to ensure America’s patients, healthcare facilities and clinical laboratories are prepared to respond to the 2019-Novel Coronavirus (COVID-19). 
CMS has developed a second Healthcare Common Procedure Coding System (HCPCS) code that can be used by laboratories to bill for certain COVID-19 diagnostic tests to help increase testing and track new cases. In addition, CMS released new fact sheets that explain Medicare, Medicaid, Children’s Health Insurance Program, and Individual and Small Group Market Private Insurance coverage for services to help patients prepare as well. 
 
 
HOSPICE: Program Integrity Manual Updated for Identity Theft and Hospice Aggregate Cap Liability, NAHC Report, March 6, 2020 – The Centers for Medicare & Medicaid Services (CMS) recently released a new transmittal that updates the chapter of the Program Integrity Manual to address coordination between Medicare Administrative Contractors (MAC) and Unified Program Integrity Contractors (UPIC) in situations of hospice aggregate cap liabilities, as well as addressing Medicare liabilities in situations of provider identity theft.
 
HOME HEALTH: CMS Proposes New Medicare Cost Report Form for Home Health Agencies, NAHC Report, March 3, 2020 – A special NAHC Report from Dave Macke, Shareholder, CHFP, FHFMA, and a member of OCHCH.
 
CMS originally issued a proposed rule on April 16, 2019, to change the Medicare cost report form set for home health agencies. This notice provided for an original 60 day comment period. On February 24, 2020, the CMS issued a revised notice of proposed home health cost report forms and provides for a second 30 day comment period. Comments must be received by the CMS no later than March 25, 2020. The CMS made some significant changes to the original notice.
 
The new forms will be known as the CMS Form 1728-19. The proposed changes were originally intended to be effective for cost reporting periods beginning on or after January 1, 2019 and ending on or after December 31, 2019. The revised effective date was changed to be effective for cost reporting periods beginning on or after July 1, 2019 and ending on or after June 30, 2020. Therefore some agencies are eight months into the affected cost reporting period and the new forms are still not yet final. We recommend that agencies implement these latest changes immediately as we do not anticipate many, if any changes during this second round of comments. Click here to read Dave’s summary of the most significant proposed changes.
 
            

>>>RCD & PDGM Needs–                                                                                                          

OPERATION: tackle is OCHCH’s campaign that supports your agency’s PDGM & RCD needs.
 

>>>RCD UPDATES –                                                                                                                  

Transition from Cycle 1 to Cycle 2 – What you need to know! Ohio Home Health providers are nearing the end of the first cycle of RCD. We wanted to update you on important information on the transition from Cycle 1 to Cycle 2.
 
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.

NEW TOOLS:

eServices: Inbox Filtering Feature Refines Review Choice Demonstration (RCD) for Home Health Services Search

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.
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.
 
Palmetto GBA Will Offer Open-Door Teleconferences on the Review Choice Demonstration: March 13, 2020
 
Monthly Review Choice Demonstration (RCD) Provider Teleconference Schedule – Next date is April 1, 2020.

Quarterly Review Choice Demonstration (RCD) Medical Review Teleconference Schedule – Next date is Tommorrow 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 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.

HOSPICE: Hospice Quality Reporting Program: Timeliness Compliance Threshold for HIS Submissions, CMS MLN Connects, March 5, 2020 – CMS posted an updated fact sheet (PDF) on the timeliness compliance threshold for Hospice Item Set (HIS) submissions, including policies finalized in the FY 2016 final rule and a preliminary algorithm for the calculation. Visit the HIS webpage for more information.
 

HOSPICE: CMS Revises Safeguards for Medicare Patients in Hospice Care Fact Sheet, NAHC Report, March 4, 2020 – As reported at the beginning of February, the Centers for Medicare & Medicaid Services (CMS) posted a MLN Hospice Fact Sheet, Safeguards for Medicare Patients in Hospice Care, and NAHC communicated with CMS regarding our concerns about some of the fact sheet’s contents. Specifically, a reference to the Long Term Care Ombudsman as a resource for patients when this type of Ombudsman does not have authority to assist hospice patients not residing in long term care facilities. Additionally, NAHC is concerned that the list of examples of potential neglect by a hospice included some examples that may not be neglect by a hospice or it is unclear if some of the listed examples would constitute neglect.