Home Health & Hospice

Weekly roundup

Homecare Insider, August 8, 2016

Pre-claim review pilot arrives in Illinois—2 days late

The 2016 Summer Olympics weren’t the only thing that started last week. On Thursday, CMS announced that the pre-claim review process was officially up and running in Illinois, effective August 3. The agency instructed home health agencies (HHA) in that state not to submit pre-claim review requests for episodes of care that began prior to August 3.

“In order to allow time to resolve an administrative procedural requirement related to the Paperwork Reduction Act, implementation of the Pre-Claim Review Demonstration for Home Health Services in Illinois began on August 3,” CMS stated in a press release, explaining that the revised start date does not impact demonstration requirements or processes, and the demonstration has been operationalized as planned for episodes of care starting on or after August 3.

Medicare administrative contractors will work directly with any HHAs that submitted requests for episodes of care that began before August 3, and will allow them to either have the requests withdrawn or processed as test requests, CMS stated. 

Source: CMS

Groups voice opposition to the pilot program

The Partnership for Quality Home Healthcare recently urged CMS to hit pause on the Medicare pre-claim review demonstration, which became active for all Medicare-certified home health agencies (HHA) in Illinois last week. In a blog post, Colin Roskey, the organization’s executive vice president, cited confusion across the industry as grounds for postponing the pilot program.

The Partnership for Quality Home Healthcare, a coalition of home health providers, wants to work with CMS to lower improper payment rates among home health claims, but the pre-claim review process isn’t the answer, according to the post.

Roskey pointed out that almost 200,000 Medicare patients in Illinois may be affected by the pre-claim review process. “We urge CMS to press the ‘pause’ button and find a better solution,” he stated. If CMS does not hit pause, the demonstration will be launched in Florida, Michigan, Texas and Massachusetts during the next few months.

Agencies and organizations nationwide have raised concerns about around additional administrative burdens, Medicare administrative contractors (MACs) ability to handle a deluge of additional submissions, and CMS’ guilty-until-proven-innocent methods of addressing claims fraud. The National Association for Home Care & Hospice (NAHC), for example, has claimed the review program makes no sense and goes too far.

For more about the home health pre-claim review pilot, see the July issue of Homecare DIRECTION.

Source: Home Health Care News

… But not everyone opposes pre-claim review

In contrast to the range of providers and others in opposition, Almost Family Inc.’s president stated his support for pre-claim review. In a press release announcing the company’s second-quarter earnings, Steve Guenthner stated that Almost Family believes the program could reduce payment errors and foster trust between providers and CMS.

“The recently released 2017 preliminary rule on Medicare home health reimbursement marks the last of four years of rebasing of home health rates. We feel CMS’ recently announced pre-claim review process, which may initially be somewhat burdensome, if properly implemented should serve to reduce real and perceived payment error rates and help build a relationship of trust between the program and providers that is critical to home health achieving its real potential in the healthcare delivery system. We support CMS’ program integrity efforts and will continue to work with them to find the best approaches to implementation.”

Almost Family had its highest-ever net service revenues, close to $156 million, across its home health nursing and personal care services businesses during the second quarter, according to the press release.

Source: Almost Family

HHAs, hospices, and Zika

Home health and hospice providers should be aware of the risk of Zika virus infection and take precautions, according to a post by Barbara B. Citarella, RN, MS, CHCE, CHS-V RBC Limited Healthcare & Management Consultants. The post appeared on the National Association for Home Care & Hospice (NAHC) website last week.

Agencies must reinforce hand hygiene, use of standard infection precautions, and use of personal protective equipment. Since travel is a contributing factor in the spread of this virus, “a complete travel history of patients and, if possible, of their family is vital,” Citarella wrote. Zika is a nationally notifiable disease, and providers should contact their local health department for guidance if they suspect a patient might be infected.

Employee travel histories are also important because many homecare workers travel for vacation and to visit family. “Providers should monitor employee illnesses for possible signs and symptoms of Zika, especially when working in an area at risk for Zika,” she advised.

Vaccines are in development, but current treatments for Zika infection include rest, fluids, and antipyretics. Agencies should provide education to all employees about Zika virus.  Because the Zika situation is evolving quickly. HHA and hospices should monitor their state department of health and CDC websites for information and updates. She also urged HHAs and hospices to post Zika informational posters in conspicuous spots throughout their offices.

Precautions include:
•    Eliminating and avoiding standing water
•    Avoiding areas with a lot of high grasses, leaves, wooded areas
•    Using only EPA-approved insect repellent as appropriate
•    Hand washing
•    Use of condoms or abstaining from sexual activity for those diagnosed with the virus.

“Remember this is a newly emerging disease with significant birth defects and we are learning more about it every day. These mosquitoes bite during the daytime, therefore daylong protection in areas identified with Zika is necessary,” Citarella wrote. “Infection prevention is imperative.”

Source: NAHC