Home Health & Hospice Articles by Topic: Payment

Is there anything agencies can do to stop HHGM from coming in 2019?

• Homecare Q&A, Issue 16, August 17, 2017

  If the HHGM as currently conceived is to be avoided, the industry must provide a large volume of...

Why is the HHGM eliminating the use of therapy service thresholds to case mix-adjust payments?

• Homecare Q&A, Issue 16, August 17, 2017

  This change is significant but not terribly surprising.

In the future, what's going to happen to requests for anticipated payment (RAP)?

• Homecare Q&A, Issue 16, August 17, 2017

  ...

How will early and late episodes work under HHGM?

• Homecare Q&A, Issue 16, August 17, 2017

  Only the first 30-day episode will be considered an early episode. The second and all later 30-day...

Why is CMS switching to a 30-day payment model?

• Homecare Q&A, Issue 16, August 17, 2017

  Based upon a data analysis, CMS concluded that on average the first 30 days of an episode were...

What happens under HHGM when an agency has a claim rejected as a questionable encounter?

• Homecare Q&A, Issue 16, August 17, 2017

  CMS states in its comments that claims for “questionable encounters” will be returned...

HHGM uses the patient's principal diagnosis to place the patient within one of six clinical groupings. Will all episodes easily fit within those categories?

• Homecare Q&A, Issue 16, August 17, 2017

  No. In the 2018 proposed PPS rule, CMS notes that 19% of episodes it reviewed in preparing for...

Homecare Q&A, August 17, 2017

• Homecare Q&A, Issue 16, August 17, 2017

  Homecare Q&A, August 17, 2017

Industry expert: New payment system detailed in PPS rule will be a "game changer"

• Homecare Direction, Issue 8, August 7, 2017

  Home health stakeholders are readying themselves for drastic changes to the way CMS plans to pay...

How does the new HHGM payment rule for 2019 affect my therapy services?

• Homecare Q&A, Issue 15, August 3, 2017

  In the new proposed home health PPS rule, CMS states agencies providing a larger percentage of...

New HHGM for 2019 is major overhaul

• Homecare E-News, Issue 29, July 31, 2017

  The introduction of the Home Health Groupings Model (HHGM) into the proposed rule means preparing...

Agencies' payments will drop in 2018

• Homecare E-News, Issue 29, July 31, 2017

  While the HHGM is the most significant long-term change for agencies’ payments, in the short...

CMS releases home health consolidated billing code changes

• Homecare E-News, Issue 45, November 28, 2016

  The Centers for Medicare & Medicaid Services (CMS) has updated the lists of HCPCS codes that...

Our questions are in regards to providing home health aide services to a patient in an assisted living facility (ALF).

• Homecare Q&A, Issue 16, August 22, 2016

  Our questions are in regards to providing home health aide services to a patient in an assisted...

I would like to know if there is a conflict with a patient being on homecare receiving skilled RN, PT, SLP, or OT in the home and also receiving cardiac or pulmonary rehab at the same time. We are operating under the premise that th

• Homecare Q&A, Issue 16, August 22, 2016

  We are operating under the premise that the patient is not driving to the appointments, but needs...

We just want to confirm that a patient coming to us from a SNF who then goes back to the SNF does not count in hospital readmission data.

• Homecare Q&A, Issue 16, August 22, 2016

  All acute care hospitalizations are “counted;” however, a SNF admission would not be...

I wanted to verify if the discharge reason in these cases would still be "Transferred to Inpatient Facility" (to match the transfer OASIS)? Or would we enter "Pt Expired" (even though the patient expired at the hospital, not at home)?

• Homecare Q&A, Issue 16, August 22, 2016

  Follow-up question to the one above: Because the patient would not be coming back to us for...

What about single physical therapy and continuing occupational therapy?

• Homecare Q&A, Issue 15, August 3, 2016

  In the PPS, there has been a big problem with coverage of occupational therapy after a single...

What do we do regarding payment for one skilled nursing home health visit?

• Homecare Q&A, Issue 15, August 3, 2016

  There is one phenomenon in the PPS that has caught the attention of medical reviewers.

Weekly Roundup

• Homecare E-News, Issue 26, July 11, 2016

  In this week's roundup: False claims penalties to double. Penalties for fraud by healthcare...

Can you please review the levels of appeals for payment?

• Homecare Q&A, Issue 13, July 3, 2016

  After the initial claim determination has been made, home health providers have the right to appeal...

Inside Story | Working with the HHRG

• Homecare E-News, Issue 25, June 27, 2016

  The CMS and medical reviewers pay close attention to patterns in care delivery and Home Health...

In Focus |Study: One size EOL expenditure does not fit all

• Homecare E-News, Issue 24, June 20, 2016

  Healthcare spending rises dramatically at the end of life (EOL), and based on this assumption...

Inside story | Calculating the episode

• Homecare E-News, Issue 22, June 6, 2016

  Editor’s note: This week’s Inside story is from The How-To Guide to Home Health...

Is our agency required to provide dressing supplies for the ulcer care if we are not providing the care for the ulcer and it is not included in written plan of care?

• Homecare Q&A, Issue 8, April 17, 2016

  We are seeing a Medicare patient for monthly skilled nursing visits to change her Foley catheter...

In Focus | CMS Correct Home Health Pricer Error

• Homecare E-News, Issue 15, April 11, 2016

  Change Request 9608, issued by the Centers for Medicare & Medicaid Services (CMS), revises a...

Under the Medicare home health benefit, does an individual who qualifies for the skilled service of insulin administration due to his blindness and no willing or able caregiver need to be homebound?

• Homecare Q&A, Issue 7, April 4, 2016

  One of the eligibility criteria for Medicare is homebound status; this must be present to qualify...

Weekly Roundup

• Homecare E-News, Issue 12, March 21, 2016

  The CMS Office of Minority Health last week unveiled a snapshot of chronic disease-related service...

Please advise regarding how a home health agency is paid if a patient elects hospice after admission. At one time, the agency was paid for an entire episode. Is this still the case? What if less than five visits were conducted?

• Homecare Q&A, Issue 6, March 18, 2016

  Please advise regarding how a home health agency is paid if a patient elects hospice after...

Following up on the previous question's example of the therapy overpayment, would the agency also be obligated to look at all the claims for that individual for the prior six years? What do you recommend regarding pre-bill audits?

• Homecare Q&A, Issue 6, March 18, 2016

  Following up on the previous question's example of the therapy overpayment, would the agency also...

What potential impact does the final rule on overpayments have on home health agencies?

• Homecare Q&A, Issue 6, March 18, 2016

  What potential impact does the final rule on overpayments have on home health agencies? For...

How do we handle Medicare as a ­secondary payer?

• Homecare Q&A, Issue 5, March 3, 2016

  Since 1980, changes in the Medicare laws have added several circumstances that identify Medicare...

In Focus | CMS Releases Hospice Cost Report

• Homecare E-News, Issue 8, February 22, 2016

  The latest version of proposed cost reporting changes for the home health-based hospices...

Inside story | Coding CAD diagnoses

• Homecare E-News, Issue 7, February 15, 2016

  February makes us think of hearts and valentines, so what better way to celebrate the month than...

Inside Focus | CMS issues a new condition code for home health claims

• Homecare E-News, Issue 7, February 15, 2016

  The Centers for Medicare & Medicaid Services (CMS) has issues a Change Request (CR) 9497. The...

Weekly roundup

• Homecare E-News, Issue 7, February 15, 2016

  CMS intends to start a Medicare Probable Fraud Measurement Pilot for home healthcare services...

In Focus | Telehealth Legislation Introduced

• Homecare E-News, Issue 6, February 8, 2016

  The Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health...

Why wouldn’t two overlapping visits be considered reimbursable by Medicare Advantage?

• Homecare Q&A, Issue 2, January 18, 2016

  One of our clients had overlapping visit times. The RN visited, provided skilled nursing care, and...

Weekly Roundup

• Homecare E-News, Issue 51, December 28, 2015

  CMS data shows cost disparities in home health services Not unlike hospital procedures and tests...

In Focus | Understanding value-based purchasing in the final rule

• Homecare E-News, Issue 49, December 14, 2015

  Although the final rule contained several notable changes to the proposed VBP pilot set to launch...

In Focus | What CJR means for home health

• Homecare E-News, Issue 48, December 7, 2015

  On November 16, 2015, the Centers for Medicare & Medicaid Services (CMS) issued the final rule...

Weekly Roundup

• Homecare E-News, Issue 48, December 7, 2015

  The National Quality Forum (NQF) announced its plan to review standardized performance measure...

Can you give tips on working with the HHRG?

• Homecare Q&A, Issue 23, December 4, 2015

  CMS and medical reviewers pay close attention to patterns in care delivery and HHRG data. They are...

In Focus | Improper payments remain an issue

• Homecare E-News, Issue 47, November 30, 2015

  The U.S. Department of Health and Human Services released its Agency Financial Report for fiscal...

Weekly Roundup

• Homecare E-News, Issue 47, November 30, 2015

  Assisted- and independent-living centers can be attractive places to do business for the home...

Weekly Roundup

• Homecare E-News, Issue 46, November 23, 2015

  Vets waiting, even dying, for home health care; telemedicine gains momentum After the Inspector...

Weekly Roundup

• Homecare E-News, Issue 44, November 9, 2015

  On Monday, November 2, the Department of Health and Human Services (HHS) Office of Inspector...

In Focus | 2016 Home Health Final Rule Released

• Homecare E-News, Issue 43, November 2, 2015

  After receiving 118 comments from the public during the official comment period, the Centers for...

The Weekly Roundup

• Homecare E-News, Issue 43, November 2, 2015

  Final Rule Released After receiving 118 comments from the public, the Centers for Medicare &...

In focus | NAHC submits comments on face-to-face clinical templates

• Homecare E-News, Issue 41, October 19, 2015

  Last Tuesday, NAHC submitted official comments to CMS on a pair of proposed clinical templates (one...

We are in disagreement about whether that is an appropriate frequency.

• Homecare Q&A, Issue 20, October 16, 2015

  We are in disagreement about whether that is an appropriate frequency.  

The Weekly Roundup

• Homecare E-News, Issue 39, October 5, 2015

  This past Thursday (October 1, 2015), began the live implementation of ICD-10 across the...

We are having an issue with noncoverage for therapy. What are the rules for therapy services to be covered? Could you explain and expand, providing some examples?

• Homecare Q&A, Issue 19, October 2, 2015

  We are having an issue with noncoverage for therapy. What are the rules for therapy services to be...

We have been told that the following documentation would position us for a potential claim denial. Can you help explain?

• Homecare Q&A, Issue 19, October 2, 2015

  We have been told that the following documentation would position us for a potential claim denial...

How do we update the comprehensive assessment for a major deterioration in status with the PPS payment requirements?

• Homecare Q&A, Issue 18, September 17, 2015

   This patient’s change in condition has a real impact on resource utilization—an...

What counts for adequate documentation for a bill-able skill?

• Homecare Q&A, Issue 18, September 17, 2015

  That documentation is not enough to translate into a billable skill. An example that would be...

What should be our frequency of visits?

• Homecare Q&A, Issue 18, September 17, 2015

   We have an 87-year-old woman who was referred by the wound care center for care of a wound...

What happens if my patient transfers to Medicare Advantage?

• Homecare Q&A, Issue 17, September 8, 2015

  The first event: The patient chooses to transfer from traditional Medicare to a Medicare Advantage...

What role do Healthcare Common Procedure Coding System (HCPCS) codes have in billing nonroutine supplies?

• Homecare Q&A, Issue 17, September 8, 2015

  These codes play no part in supply reporting or payment. An agency reports supplies; it does not...

Can we provide two home health aides to provide care for a quadriplegic patient?

• Homecare Q&A, Issue 15, August 3, 2015

  Yes, Medicare will cover two visits if two individuals are needed to perform a covered service...

What criteria apply to the patient receiving outpatient therapy under the consolidated billing requirement?

• Homecare Q&A, Issue 15, August 3, 2015

  Because this is therapy that an agency would provide if the equipment were available, the same...

When do we ever admit patients and not teach them?

• Homecare Q&A, Issue 15, August 3, 2015

  There are very few times that a clinician will admit a patient and not complete some teaching...

Will Medicare cover nursing services twice daily for a PICC line flush and dressing change?

• Homecare Q&A, Issue 15, August 3, 2015

  Flushing a peripherally inserted central catheter (PICC) line does indeed require the skills of a...

If the patient has an ostomy, cannot change it, and there are no caregivers to learn, does the agency stay in indefinitely?

• Homecare Q&A, Issue 15, August 3, 2015

  Changing an ostomy bag, even if the patient can’t do it and there’s no caregiver...

When does Medicare consider a wound as chronic/nonhealing and no longer pays for services?

• Homecare Q&A, Issue 15, August 3, 2015

  You won’t find any mention in the Medicare coverage criteria about chronic or nonhealing...

Is it an appropriate use of Medicare to do three weeks of assessment and venipuncture for a patient hospitalized with DVT?

• Homecare Q&A, Issue 15, August 3, 2015

  Since 1997, venipuncture has not been a qualifying service for Medicare coverage. However, once the...

Is it permissible for a hospital discharge planner to make an entry into a patient hospital record and have the physician sign the entry (to support home health eligibility)?

• Homecare Q&A, Issue 15, August 3, 2015

  Is it permissible for a hospital discharge planner to make an entry into a patient hospital record...

Is it true that we must receive the signed plan of care and all verbal orders prior to submitting the claim?

• Homecare Q&A, Issue 14, July 16, 2015

  Yes, it’s true. You can find that requirement in CMS Publication 100-2, Chapter...

Is homecare obligated to provide all diabetic supplies to Medicare patients while on service?

• Homecare Q&A, Issue 14, July 16, 2015

  The agency is required to supply all supplies on the NRS list.

Does Medicare cover ostomy supplies for ureterostomies?

• Homecare Q&A, Issue 14, July 16, 2015

  All ostomy supplies are covered under the NRS. For a current NRS master supply list, see the...

Can physical therapy go out and have consents signed and perform an evaluation before the nurse gets to the home to complete the OASIS as long as it is all done the same day?

• Homecare Q&A, Issue 14, July 16, 2015

  The only similar guidance found was according to CMS’ OASIS Q&A:

I am wondering how to answer OASIS assessment "M" items when an OASIS assessment is needed for a payer change, but one does not exist.

• Homecare Q&A, Issue 14, July 16, 2015

  Thanks for your question and commitment to compliance. In cases where you learn after the fact...

Can physical therapy be considered the qualifying service to establish a need for ongoing occupational therapy?

• Homecare Q&A, Issue 13, July 2, 2015

  Occupational therapy cannot qualify a patient for coverage initially, but after the patient has had...

What can trigger an ABN, and what must be documented? What about an HHCCN?

• Homecare Q&A, Issue 13, July 2, 2015

  The ABN (CMS-R-131) is a written notice that the agency must provide to a PPS Medicare-eligible...

Should there be one signature per order, or can orders be batch signed?

• Homecare Q&A, Issue 13, July 2, 2015

  As long as the order is a complete order for a treatment or therapy, you may have more than one...

Homecare Q&A

• Homecare Q&A, Issue 13, July 2, 2015

  July 3, 2015

If an agency discharges a patient with goals met but then readmits him or her within 60 days of discharge, would the new episode be an early or later one for M0110, episode timing?

• Homecare Q&A, Issue 12, June 15, 2015

  If an agency discharges a patient with goals met but then readmits him or her within 60 days of...

How do we determine diagnosis and priority?

• Homecare Q&A, Issue 12, June 15, 2015

  Q: We are seeing a patient with Alzheimer’s disease, who was hospitalized for advanced...

What about goals, rehabilitation potential, and discharge plans? What are some key points we need to keep in mind while entering those into the 485?

• Homecare Q&A, Issue 12, June 15, 2015

  What about goals, rehabilitation potential, and discharge plans? What are some key points we need...

What is the proper way to enter in orders for disciplines and treatments on the 485?

• Homecare Q&A, Issue 12, June 15, 2015

  What is the proper way to enter in orders for disciplines and treatments on the 485?

Where can I find that it would be illegal to charge a Medicare home health patient prior to rendering services, while reimbursing patient once CMS has paid the claim?

• Homecare Q&A, Issue 12, June 15, 2015

  Assignment of benefits - This term means that the facility or the physician agrees to accept...

Are other agencies billing for the final skilled visit when the discharge reason is no longer homebound?

• Homecare Q&A, Issue 11, June 3, 2015

   A clinician arrives at the home, where skilled services are provided. Based on the...

Can we use "zero" as a frequency in writing physician orders?

• Homecare Q&A, Issue 10, May 17, 2015

  Can we use “zero” as a frequency in writing physician orders? For example, physical...

What should you do about a tardy recertification assessment?

• Homecare Q&A, Issue 9, May 3, 2015

  What should you do about a tardy recertification assessment? It’s the fifth day of the...

How do we get paid when we have two different payers?traditional Medicare (Part A) and MA?within the same 60-day episode?

• Homecare Q&A, Issue 9, May 3, 2015

  How do we get paid when we have two different payers—traditional Medicare (Part A) and...

What happens to patients who can self-inject but cannot pre-fill insulin syringes?

• Homecare Q&A, Issue 9, May 3, 2015

  What happens to patients who can self-inject but cannot pre-fill insulin syringes?

When does Medicare consider a wound as chronic/nonhealing and no longer pay for services?

• Homecare Q&A, Issue 9, May 3, 2015

  When does Medicare consider a wound as chronic/nonhealing and no longer pay for services?

What would be the response for M0150, Current Payment Sources, for an MA patient?

• Homecare Q&A, Issue 9, May 3, 2015

  What would be the response for M0150, Current Payment Sources, for an MA patient?

When are you to begin counting the 30 days from assessment to assessment?

• Homecare Q&A, Issue 8, April 17, 2015

  The final rule, and the corresponding correction that CMS put out regarding the therapy...

When responding to home health services provided January 1, 2015, and beyond, and we receive an ADR [additional development request] related to LUPA or 5-7 visits, do we need to include face-to-face documents with the ADR information?

• Homecare Q&A, Issue 7, April 3, 2015

   All Medicare patients for whom you bill, regardless of whether they are LUPA, require a...

How can we ensure we?re meeting and documenting eligibility requirements effectively?

• Homecare Q&A, Issue 7, April 3, 2015

  Before offering the Medicare Hospice Benefit (MHB) to a beneficiary, the hospice must first verify...

Is a patient who is toileted every two hours covered under Medicare?

• Homecare Q&A, Issue 6, March 17, 2015

  In combination, the nurse and HHA can provide up to 35 hours a week in medically necessary...

Is it true that we need to change our process and submit ALL OASIS assessments to the AS

• Homecare Q&A, Issue 6, March 17, 2015

   Yes, all Medicare, Medicare Advantage, and Medicaid OASIS assessments must be transmitted.

Will home health remain exempt from overtime compensation in most circumstances like it has for 40 years?

• Homecare Insider, Issue 1, January 5, 2015

  Will home health remain exempt from overtime compensation in most circumstances like it has for 40...