Home Health & Hospice

Weekly roundup

Homecare Insider, July 18, 2016

Home Health Star Rating previews are now available to agencies

CMS has announced the Quality of Patient Care Star Ratings Preview Reports are now available in agencies’ Certification And Survey Provider Enhanced Reports (CASPER) folders. These reports contain data that will be publicly reported on the Home Health Compare website in October 2016. Starting this quarter, the preview report includes additional information about the rating and how the results shown on the scorecard can be used by agencies for quality improvement.

The Quality of Patient Care Star Rating is based on OASIS assessments and Medicare claims data. All Medicare-certified home health agencies (HHA) are eligible to receive a Quality of Patient Care Star Rating.
Currently, HHAs must have at least 20 complete quality episodes for data for each measure to be reported on HHC. (Completed episodes are paired start- or resumption-of-care and end-of-care OASIS assessments.) Episodes must have an end-of-care date within the 12-month reporting period regardless of start date. To receive a Quality of Patient Care Star Rating, HHAs must have reported data for five of the nine measures used in the Quality of Patient Care Star Ratings calculation. 

The deadline to submit a request to have the star rating data suppressed is July 25, 2016. Please follow the directions in the Preview Reports to submit a suppression request.  

Source: CMS

Weigh in on OASIS-C2, pre-claim review

There is still time to voice your comments on two important CMS initiatives regarding home health:

Comments for the home health pre-claim review demonstration project are due by July 21. A second request for comments was issued in the Federal Register on June 21. For more about the home health pre-claim review demonstration project, see the July issue of Homecare DIRECTION.

Comments for OASIS C2, scheduled for implementation on January 1, 2017, are due by August 1. A second request for comments was announced in the Federal Register on June 30.

Instructions for submitting comments can be found in the Federal Register information for each initiative.

Source: Office of the Federal Register

Next forum for pre-claim review is Wednesday

CMS will host a third Special Open Door Forum conference call to allow HHAs, physicians, and other interested parties to learn about the pre-claim review demonstration for home health services. Two Medicare Administrative Contractors, Palmetto GBA and CGS, will be available for questions. Palmetto GBA will present on its activities to prepare for the demonstration launch in Illinois, and will provide an overview of its Web portal submission tool. 

CMS will be implementing a three-year Medicare pre-claim review demonstration for home health services in Illinois, Florida, Texas, Michigan, and Massachusetts. CMS is testing whether pre-claim review helps reduce expenditures, while maintaining or improving quality of care. 

Source: CMS

Hospice timeliness threshold report goes live

In Sections E.6.d and E.6.e of the Final Rule for fiscal year 2016, CMS finalized a timeliness compliance threshold for HIS submissions. These policies went into effect for the FY 2018 reporting year, which began January 1, 2016. The Hospice Timeliness Compliance Threshold Report was slated to be available beginning July 17.

The report includes provider-level data on Hospice Item Set (HIS) records submitted successfully to CMS, and displays the following information:
•    Provider identification information
•    Provider CCN and FAC identification
•    Number of HIS records submitted
•    Number of HIS records submitted on time
•    Percentage of HIS records submitted on time.

Beginning with the FY 2018 reporting year, hospices are required to submit a minimum percentage of their HIS records by the 30-day submission deadline, or face a 2% reduction in their Annual Payment Update (APU). For the FY 2018 APU determination, at least 70% of all required HIS records must be submitted within the 30-day submission deadline.

The compliance threshold is related to the submission deadline for HIS records only. Completion deadlines will not be considered in the timeliness compliance threshold calculations, according to CMS.

Source: CMS

Hospice provider to pay $18M in bogus claims case

Evercare Hospice and Palliative Care will pay $18 million to resolve allegations that it claimed Medicare reimbursement for hospice care for patients who were not eligible for such care because they were not terminally ill, the U.S. Department of Justice (DoJ) announced last week. Evercare, now known as Optum Palliative and Hospice Care, is a Minnesota-based provider of hospice care in Arizona, Colorado and other states across the United States.

In a lawsuit brought by the government, Evercare allegedly knowingly submitted or caused to be submitted false claims to Medicare for hospice care from January 1, 2007, through December 31, 2013, for Medicare patients who were not eligible for the Medicare hospice benefit because Evercare’s medical records did not support that they were terminally ill.

The suit alleged that Evercare’s business practices included discouraging physicians from recommending that ineligible patients be discharged from hospice and failing to ensure that nurses accurately and completely documented patients’ conditions in the medical records.

The allegations arose from whistleblower lawsuits initially filed by former employees of Evercare under the provisions of the False Claims Act. The share to be awarded in this case has not yet been determined.

Source: DoJ