Home Health & Hospice Articles by Topic: Payment

PDGM is here to stay, focus on preparations for January roll-out

• Homecare Direction, Issue 12, December 6, 2019

  CMS is moving full steam ahead toward implementation of the Patient-Driven Groupings Model (PDGM...

CMS reduces behavioral adjustments, moves ahead with RAP phase-out plan

• Homecare Direction, Issue 11, November 8, 2019

  CMS has eased off of plans to implement an 8.01% decrease in agencies’ payments due to...

The patient was discharged from the hospital Oct. 30. Is it best to discharge the patient and complete a new SOC? Or should our agency complete a resumption of care (ROC)?

• Homecare Q&A, Issue 10, October 28, 2019

  Under PDGM, when a patient is admitted to an acute care hospital, the agency will proceed with a...

If a patient has a significant change in the middle of the first 30-days period, does a new plan of care have to be submitted, and what are recommendations for coding with that?

• Homecare Q&A, Issue 8, August 26, 2019

  It depends on the agency’s policy but if the patient’s change is really significant...

Is it better to get a PEP on an episodes than avoiding the LUPA threshold?

• Homecare Q&A, Issue 8, August 26, 2019

  Agencies should follow whatever would be the most compliant process for the situation.

CMS puts more weight on behavioral assumptions, but increases payments by 1.3%

• Homecare Direction, Issue 8, August 7, 2019

  CMS is seeking to reduce agency payments even more than expected to account for assumed behavioral...

Don't delay preparations: CMS stays on course for 2020 PDGM implementation

• Homecare Direction, Issue 8, August 7, 2019

  With a new payment model set to take effect in less than six months, agencies cannot afford to...

Take steps to avoid cash flow disruptions as CMS seeks to eliminate RAPs

• Homecare Direction, Issue 8, August 7, 2019

  Evaluate cash flow to see how your agency would perform if requests for anticipated payment (RAPs...

2020 proposed, estimated 30-day budget-neutral payment amounts

• Homecare Direction, Issue 8, August 7, 2019

  This table, taken from the 2020 PPS proposed rule, includes the proposed, estimated 30-day...

Should we code all diagnoses or only those affecting the plan of care?

• Homecare Q&A, Issue 7, July 29, 2019

  Unfortunately this is an instance of where we have conflicting regulations.

How can intake help us avoid unspecified abnormalities of gait as a primary diagnosis?

• Homecare Q&A, Issue 6, June 28, 2019

  Intake could say to the referral source, “Does the patient have any neuropathy? Does the...

What should intake do with a primary diagnosis of M62.81?

• Homecare Q&A, Issue 6, June 28, 2019

  Since we know that’s going to be not acceptable as a primary diagnosis under PDGM, that is a...

Take these crucial actions to ensure success during CMS' Review Choice Demo

• Homecare Direction, Issue 6, June 6, 2019

  Agencies seeking to pass CMS’ Review Choice Demonstration (RCD) with flying colors should...

CMS updates providers about hospice star ratings, OASIS-D1, PDGM

• Homecare Direction, Issue 6, June 6, 2019

  CMS is conducting data analysis to prepare for possible introduction of star ratings on Hospice...

Can you give tips on M1860 (Ambulation/locomotion)?

• Homecare Q&A, Issue 4, April 18, 2019

  You note that your agency is preparing for PDGM.

Find the balance between preparing for PDGM and living in the current PPS world

• Homecare Direction, Issue 4, April 8, 2019

  While experts agree it’s important to start preparing now for the Patient-Driven Groupings...

CMS officials provide detailed overview of PDGM and how it will affect agencies

• Homecare Direction, Issue 3, March 6, 2019

  Three scenarios CMS officials walked agencies through during a Feb. 12 call about the...

CMS suppresses RAP payments for all new home health agencies nationwide

• Homecare Direction, Issue 3, March 6, 2019

  In the short term, a new MLN Matters article announcing CMS will suppress payments associated with...

Change request gives key details about PDGM in advance of 2020 implementation

• Homecare Direction, Issue 3, March 6, 2019

  A new change request from CMS implements the policies of the Patient-Driven Groupings Model (PDGM...

For PDGM, agencies will need to change how they handle case conferencing

• Homecare Direction, Issue 2, February 5, 2019

  Case conferences will take on increased importance when the Patient-Driven Groupings Model (PDGM...

Reduced rural add-on payments cause agencies to create efficiencies

• Homecare Direction, Issue 2, February 5, 2019

  Rural add-on payments have changed significantly for many agencies this year, with some providers...

CMS provides updates about OASIS-D, PDGM, hospice billing

• Homecare Direction, Issue 2, February 5, 2019

  Use CMS’ new GG self-care and mobility activity decision tree to determine appropriate...

What about the F2F requirements? Should we treat all payers the same and require the same as Medicare?

• Homecare Q&A, Issue 1, January 16, 2019

  Face to Face is a Conditions of Payment requirement and is required for Medicare and Medicaid.

What strategies would you advise rural agencies use in 2019 to help withstand the phase-out?

• Homecare Q&A, Issue 1, January 16, 2019

  You explain that your  agency is based in a rural area, and beginning this year the rural...

How should we speak with staff about shifting away from the pay-per visit model?

• Homecare Q&A, Issue 1, January 16, 2019

  You note that your agency is considering shifting away from a pay-per visit model for clinicians...

Faster documentation will be crucial to success under PDGM: Take time to prepare now

• Homecare Direction, Issue 1, January 4, 2019

  Make completing documentation in the home a requirement for all clinicians. Doing so will improve...

Year of data show agencies fared poorly in targeted probe and educate

• Homecare Direction, Issue 1, January 4, 2019

  Newly released data show a massive percentage of agencies participating in CMS’ targeted...

What led Illinois agencies' improvement in the pre-claim demo?

• Homecare Q&A, Issue 17, December 17, 2018

  Learning and implementing the feedback loop.  

In the review choice demo, why would an agency choose a post-payment review option instead of pre-claim?

• Homecare Q&A, Issue 17, December 17, 2018

  If you feel pretty confident as an agency that your documentation can pass muster and the totality...

Will community-based agencies survive in PDGM?

• Homecare Q&A, Issue 17, December 17, 2018

  Although the new payment model does not value community-based referrals as well, I believe that...

Do you see hospital-based agencies being more successful under PDGM?

• Homecare Q&A, Issue 17, December 17, 2018

  Hospital-based agencies are going to have more institutional admits than community admits.  

Where and how does value-based purchasing fit into PDGM?

• Homecare Q&A, Issue 17, December 17, 2018

  Home health value-based purchasing is a separate rewards system.  

Can you explain how partial episode payments (PEPs) will work under PDGM?

• Homecare Q&A, Issue 17, December 17, 2018

  First let’s go over how a PEP works.  

Now that CMS has finalized PDGM, agencies must begin preparing immediately

• Homecare Direction, Issue 12, December 5, 2018

  Agencies that wait until the last minute to prepare for the Patient-Driven Groupings Model (PDGM...

PPS rule finalizes 2.2% payment increase for home health agencies in 2019

• Homecare Direction, Issue 12, December 5, 2018

  Adjustments to Medicare’s home health payments under the 2019 PPS final rule will increase...

What's roughly the average amount of time it should take a home health agency to submit a bill under PPS (from the day of admission)?

• Homecare Q&A, Issue 16, November 20, 2018

  For a final claim, (which is sent at the end of the 60-day period), there should be enough time to...

My agency appears to be losing a significant amount of money under PDGM. What strategies would you recommend I take?

• Homecare Q&A, Issue 16, November 20, 2018

  PDGM is designed to be budget neutral, but the impact on payment depends on type of provider and...

For some choices in review choice demo, there are no takebacks

• Homecare Direction, Issue 11, November 5, 2018

  While agencies have choices when it comes to which claim review option to select for CMS&rsquo...

PDGM to require even more cooperation between clinician, biller

• Homecare Direction, Issue 11, November 5, 2018

  It’s essential that agencies work to make their billing departments as efficient as possible...

House bill seeks to eliminate behavioral assumptions from PDGM

• Homecare Direction, Issue 10, October 4, 2018

  A new House bill seeks to eliminate the use of behavioral assumptions when determining payment...

New case-mix methodology forces agencies to pivot

• Homecare Direction, Issue 10, October 4, 2018

  Old patterns of thinking about the kinds of services patients need and when to provide them could...

What should I do if I take on a patient with a diagnosis that fits within one of the six clinical groups under PDGM?

• Homecare Q&A, Issue 14, September 21, 2018

  The 2019 proposed PPS rule references this concern in several areas.

What recommendations/strategies do you have for gathering documentation fast so we can bill quicker under PDGM?

• Homecare Q&A, Issue 14, September 21, 2018

  CMS estimates the median length of days for request for anticipated payment (RAP) submission is 12...

If my agency makes drastic changes to adapt to PDGM, might CMS target us as though we're committing fraud?

• Homecare Q&A, Issue 14, September 21, 2018

  At this point, I would suggest you don't do anything drastic.

We have a conflict occurring related to documentation and billing. Can you help?

• Homecare Q&A, Issue 13, September 4, 2018

  In the scenario you discuss, your agency’s billing department reviews documentation before...

What impact will there be from CMS' proposal for agencies to list remote patient monitoring on cost reports?

• Homecare Q&A, Issue 13, September 4, 2018

  One portion of the proposed PPS rule seeks changes to have agencies list remote patient monitoring...

Increase coding specificity to protect payment, ensure valid episodes under PDGM

• Homecare Direction, Issue 9, September 1, 2018

  Analyze your agency’s most commonly used primary diagnosis codes as a first step toward...

Appeals backlog shrinks, but it won't be eliminated as quickly as ordered

• Homecare Direction, Issue 9, September 1, 2018

  There’s good news for agencies caught up in the daunting backlog of appeals at the...

CMS details its plan to revise the home health payment model beginning in 2020

• Homecare Direction, Issue 8, August 1, 2018

  A year after outcry from the home health industry caused CMS to step back from proposed plans to...

Proposal calls for payment increase -- that's right, increase -- for agencies

• Homecare Direction, Issue 8, August 1, 2018

  For the first time in at least a decade, the proposed home health payment rule discusses increasing...

Are there things we should do differently with claims to prepare for PDGM?

• Homecare Q&A, Issue 12, July 25, 2018

  PDGM is going to be such a rapid cycle flurry of action.

What's an example of a billing aberrancy that's prompting contractors to target agencies in targeted probe-and-educate reviews?

• Homecare Q&A, Issue 12, July 25, 2018

  We see inappropriate recertifications all over the place.

Proposed PPS rule calls for $400-million payment increase, details new payment model

• Homecare Direction, Issue 7, July 5, 2018

  Adjustments to Medicare’s home health payments under the 2019 proposed PPS rule would...

What suggestions do you have for how agencies can achieve success on pre- or post-payment reviews?

• Homecare Q&A, Issue 10, June 11, 2018

  Agencies need to begin now to ensure that they are getting valid face-to-face documentation with...

Hospice rule data show SIA payments aren't increasing visits at end of life

• Homecare Direction, Issue 6, June 4, 2018

  Some hospice industry experts were taken aback by CMS’ latest analysis of service intensity...

Could you share some examples of things that might flag agencies as outliers in billing when it comes to the targeted probe-and-educate review?

• Homecare Q&A, Issue 9, May 12, 2018

  The purpose of the targeted probe-and-educate review is to reduce improper payments by auditing...

How likely is that CMS adopts a payment model other than the Home Health Groupings Model? And other than there being budget neutrality this time around, what aspects might change from what was proposed last year?

• Homecare Q&A, Issue 8, April 17, 2018

  We?re going to see something along the lines of the Home Health Groupings Model.

Does eliminating therapy thresholds under a revised payment model such as HHGM mean that regardless of how many therapy visits an agency provides, payments will remain the same?

• Homecare Q&A, Issue 8, April 17, 2018

  It remains to be seen what the new payment model will look like.

Take better care of patients with hypertension diagnosis to avoid MAC scrutiny

• Homecare Direction, Issue 4, April 12, 2018

  Thoroughly examine clinicians’ documen-tation — and ensure it’s detailed...

New CMS transmittal explains how rural add-on payments will be processed

• Homecare Direction, Issue 4, April 12, 2018

  Rural agencies might have to wait a while before they get 3% add-on payments for claims submitted...

Our agency sometimes admits the same patient as another facility, which messes up our payment. How do we avoid this?

• Homecare Q&A, Issue 7, April 3, 2018

  When two agencies admit the same beneficiary within the same general timeframe, the common working...

MedPAC--yet again--recommends 5% home health payment reductions

• Homecare E-News, Issue 13, March 26, 2018

  The Medicare Payment Advisory Commission (MedPAC) is once again recommending a 5% Medicare payment...

Please advise: At one time, if a Medicare patient was receiving home health visits, and switched to a hospice, the agency was paid the episode rate for care (regardless of the number of visits). Has this changed?

• Homecare Q&A, Issue 6, March 17, 2018

  Please advise: At one time, if a Medicare patient was receiving home health visits, and switched...

How did the budget act affect home health?

• Homecare Q&A, Issue 4, February 19, 2018

  On Friday, February 9, President Trump signed into law a bill designed to keep the federal...

CMS proposes nonskilled service coverage as additional benefit to Medicare Advantage

• Homecare E-News, Issue 8, February 19, 2018

  On February 1, 2018, CMS proposed new Medicare Advantage and Part D payment and policy updates to...

President Trump signs bill that creates new home health payment model

• Homecare E-News, Issue 7, February 12, 2018

  On Friday, February 9, President Trump signed into law a bill designed to keep the federal...

Shorter lengths of stay can hurt patients and affect hospices' bottom lines

• Homecare Direction, Issue 2, February 12, 2018

  A short but intense stay on the routine home care level of care — the care level most...

CMS works to ensure correct processing of disaster-related home health claims

• Homecare E-News, Issue 6, February 5, 2018

  Agencies submitting claims under a waiver authorized in response to recent hurricane and wildfire...

What do we do if we have an account that can't be collected? How can we better manage and monitor accounts receivable?

• Homecare Q&A, Issue 3, February 2, 2018

  Writing off an account is never preferable, but when an account cannot be collected, sometimes it...

VA, HHS announce partnership to strengthen prevention of fraud, waste and abuse efforts

• Homecare E-News, Issue 5, January 29, 2018

  On January 23, the U.S. Department of Veterans Affairs (VA) and HHS announced a partnership to...

Our agency looks at the PEPPER reports, but what pieces of information are most important?

• Homecare Q&A, Issue 2, January 17, 2018

  Note PEPPER’s six target areas: Average case mix. This target area calculates average case...

Improve documentation, avoid pitfalls ahead of tar-geted probe-and-educate review

• Homecare Direction, Issue 1, January 15, 2018

  Between the cost of denials and additional staffing expenses to cover the time in-volved in...

CoPs will impact operations, financials more than any other requirement in 2018

• Homecare Direction, Issue 1, January 8, 2018

  Within the revised Home Health Condi-tions of Participation (CoP) slated to take effect January...

CJR localities halved; hip fracture episode payment model eliminated

• Homecare E-News, Issue 46, December 4, 2017

  CMS has finalized its plan to cancel four mandatory episode payment models for common cardiac and...

CMS will not move forward with Home Health Groupings Model in 2019

• Homecare Direction, Issue 12, December 4, 2017

  Actions that home health agencies and advocacy or-ganizations took to combat CMS’ proposed...

New low-volume option could shrink the line of appeals at the ALJ level

• Homecare E-News, Issue 43, November 13, 2017

  Home health agencies and other providers with a low volume of pending appeals at the administrative...

CMS decides not to move forward with Home Health Groupings Model in 2019

• Homecare E-News, Issue 42, November 2, 2017

  Agencies can breathe a deep sigh of relief. CMS won’t launch its drastically revised home...

NAHC attendees receive details about targeted re-views and odds HHGM will happen

• Homecare Direction, Issue 11, November 1, 2017

  The big buzz at the National Association for Home Care & Hospice (NAHC) an-nual conference in...

NAHC interim president: Odds of HHGM happening in 2019 are 50/50

• Homecare E-News, Issue 40, October 23, 2017

  The odds of the home health industry avoiding the Home Health Groupings Model in 2019 have...

How would we bill the following scenario?

• Homecare Q&A, Issue 20, October 17, 2017

  On Monday, a nurse assesses the patient’s condition, assesses the wound, and applies a new...

CMS shifts from denials to RTPs for home health claims with no matching OASIS

• Homecare E-News, Issue 39, October 16, 2017

  Home health agencies will now have their claims returned when Medicare systems fail to match those...

HHGM draws widespread disdain: More than 1,300 commenters chime in on CMS proposal

• Homecare Direction, Issue 10, October 9, 2017

  Home health agencies spoke up in record numbers about their concerns with the proposed 2018 PPS...

What exactly are the regulations for hospice patients who travel in terms of billing?

• Homecare Q&A, Issue 18, September 19, 2017

  From time to time, hospice patients may travel outside of their current hospice provider’s...

Coding corner: FY 2018 coding guide-lines: "In" will be equivalent to "with" starting October 1

• Homecare Direction, Issue 9, September 18, 2017

  Conditions linked in the Alphabetic Index by the word “in” should be considered...

Hospice Provider Preview Reports Available

• Homecare E-News, Issue 34, September 11, 2017

  Hospice providers are encouraged to preview their quality measure results based on Quarter 1- 2016...

What do we do if we think Medicare might be a secondary payer?

• Homecare Q&A, Issue 17, August 31, 2017

  Focus on documentation. CMS believes it is the responsibility of the homecare provider to attempt...

How do we go about an admission that was visited only by a nurse during start of care then transferred to the hospital?

• Homecare Q&A, Issue 17, August 31, 2017

  Q46.1. If we admit a Medicare patient to our home health agency and complete a SOC...

CMS proposed rule changes bundled payments

• Homecare E-News, Issue 32, August 21, 2017

  A proposed rule (CMS-5524-P) released by CMS on August 15, 2017 would make the Comprehensive Care...

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...

Turn the Trump transition into success for your agency

• Beacon Institute On-Demand Webcast Library, Issue 2, February 28, 2017

  Turn the Trump transition into success for your agency

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...