Home Health & Hospice Articles by Topic: Payment
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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...
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Homecare Direction, Issue 8, August 1, 2018
For the first time in at least a decade, the proposed home health payment rule discusses increasing...
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Homecare Q&A, Issue 12, July 25, 2018
PDGM is going to be such a rapid cycle flurry of action.
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Homecare Q&A, Issue 12, July 25, 2018
We see inappropriate recertifications all over the place.
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Homecare Direction, Issue 7, July 5, 2018
Adjustments to Medicare’s home health payments under the 2019 proposed PPS rule would...
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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...
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Homecare Direction, Issue 6, June 4, 2018
Some hospice industry experts were taken aback by CMS’ latest analysis of service intensity...
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Homecare Q&A, Issue 9, May 12, 2018
The purpose of the targeted probe-and-educate review is to reduce improper payments by auditing...
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Homecare Q&A, Issue 8, April 17, 2018
We?re going to see something along the lines of the Home Health Groupings Model.
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Homecare Q&A, Issue 8, April 17, 2018
It remains to be seen what the new payment model will look like.
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Homecare Direction, Issue 4, April 12, 2018
Thoroughly examine clinicians’ documen-tation — and ensure it’s detailed...
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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...
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Homecare Q&A, Issue 7, April 3, 2018
When two agencies admit the same beneficiary within the same general timeframe, the common working...
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Homecare E-News, Issue 13, March 26, 2018
The Medicare Payment Advisory Commission (MedPAC) is once again recommending a 5% Medicare payment...
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Homecare Q&A, Issue 6, March 17, 2018
Please advise: At one time, if a Medicare patient was receiving home health visits, and switched...
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Homecare Q&A, Issue 4, February 19, 2018
On Friday, February 9, President Trump signed into law a bill designed to keep the federal...
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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...
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Homecare E-News, Issue 7, February 12, 2018
On Friday, February 9, President Trump signed into law a bill designed to keep the federal...
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Homecare Direction, Issue 2, February 12, 2018
A short but intense stay on the routine home care level of care — the care level most...
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Homecare E-News, Issue 6, February 5, 2018
Agencies submitting claims under a waiver authorized in response to recent hurricane and wildfire...
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Homecare Q&A, Issue 3, February 2, 2018
Writing off an account is never preferable, but when an account cannot be collected, sometimes it...
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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...
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Homecare Q&A, Issue 2, January 17, 2018
Note PEPPER’s six target areas:
Average case mix. This target area calculates average case...
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Homecare Direction, Issue 1, January 15, 2018
Between the cost of denials and additional staffing expenses to cover the time in-volved in...
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Homecare Direction, Issue 1, January 8, 2018
Within the revised Home Health Condi-tions of Participation (CoP) slated to take effect January...
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Homecare E-News, Issue 46, December 4, 2017
CMS has finalized its plan to cancel four mandatory episode payment models for common cardiac and...
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Homecare Direction, Issue 12, December 4, 2017
Actions that home health agencies and advocacy or-ganizations took to combat CMS’ proposed...
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Homecare E-News, Issue 43, November 13, 2017
Home health agencies and other providers with a low volume of pending appeals at the administrative...
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Homecare E-News, Issue 42, November 2, 2017
Agencies can breathe a deep sigh of relief. CMS won’t launch its drastically revised home...
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Homecare Direction, Issue 11, November 1, 2017
The big buzz at the National Association for Home Care & Hospice (NAHC) an-nual conference in...
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Homecare E-News, Issue 40, October 23, 2017
The odds of the home health industry avoiding the Home Health Groupings Model in 2019 have...
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Homecare Q&A, Issue 20, October 17, 2017
On Monday, a nurse assesses the patient’s condition, assesses the wound, and applies a new...
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Homecare E-News, Issue 39, October 16, 2017
Home health agencies will now have their claims returned when Medicare systems fail to match those...
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Homecare Direction, Issue 10, October 9, 2017
Home health agencies spoke up in record numbers about their concerns with the proposed 2018 PPS...
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Homecare Q&A, Issue 18, September 19, 2017
From time to time, hospice patients may travel outside of their current hospice provider’s...
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Homecare Direction, Issue 9, September 18, 2017
Conditions linked in the Alphabetic Index by the word “in” should be considered...
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Homecare E-News, Issue 34, September 11, 2017
Hospice providers are encouraged to preview their quality measure results based on Quarter 1- 2016...
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Homecare Q&A, Issue 17, August 31, 2017
Focus on documentation. CMS believes it is the responsibility of the homecare provider to attempt...
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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...
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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...
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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...
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Homecare Q&A, Issue 16, August 17, 2017
This change is significant but not terribly surprising.
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Homecare Q&A, Issue 16, August 17, 2017
...
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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...
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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...
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Homecare Q&A, Issue 16, August 17, 2017
CMS states in its comments that claims for “questionable encounters” will be returned...
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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...
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Homecare Q&A, Issue 16, August 17, 2017
Homecare Q&A, August 17, 2017
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Homecare Direction, Issue 8, August 7, 2017
Home health stakeholders are readying themselves for drastic changes to the way CMS plans to pay...
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Homecare Q&A, Issue 15, August 3, 2017
In the new proposed home health PPS rule, CMS states agencies providing a larger percentage of...
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Homecare E-News, Issue 29, July 31, 2017
The introduction of the Home Health Groupings Model (HHGM) into the proposed rule means preparing...
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Homecare E-News, Issue 29, July 31, 2017
While the HHGM is the most significant long-term change for agencies’ payments, in the short...
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Beacon Institute On-Demand Webcast Library, Issue 2, February 28, 2017
Turn the Trump transition into success for your agency
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Homecare E-News, Issue 45, November 28, 2016
The Centers for Medicare & Medicaid Services (CMS) has updated the lists of HCPCS codes that...
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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...
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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...
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Homecare Q&A, Issue 16, August 22, 2016
All acute care hospitalizations are “counted;” however, a SNF admission would not be...
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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...
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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...
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Homecare Q&A, Issue 15, August 3, 2016
There is one phenomenon in the PPS that has caught the attention of medical reviewers.
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Homecare E-News, Issue 26, July 11, 2016
In this week's roundup:
False claims penalties to double. Penalties for fraud by healthcare...
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Homecare Q&A, Issue 13, July 3, 2016
After the initial claim determination has been made, home health providers have the right to appeal...
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Homecare E-News, Issue 25, June 27, 2016
The CMS and medical reviewers pay close attention to patterns in care delivery and Home Health...
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Homecare E-News, Issue 24, June 20, 2016
Healthcare spending rises dramatically at the end of life (EOL), and based on this assumption...
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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...
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Homecare Q&A, Issue 8, April 17, 2016
We are seeing a Medicare patient for monthly skilled nursing visits to change her Foley catheter...
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Homecare E-News, Issue 15, April 11, 2016
Change Request 9608, issued by the Centers for Medicare & Medicaid Services (CMS), revises a...
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Homecare Q&A, Issue 7, April 4, 2016
One of the eligibility criteria for Medicare is homebound status; this must be present to qualify...
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Homecare E-News, Issue 12, March 21, 2016
The CMS Office of Minority Health last week unveiled a snapshot of chronic disease-related service...
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Homecare Q&A, Issue 6, March 18, 2016
Please advise regarding how a home health agency is paid if a patient elects hospice after...
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Homecare Q&A, Issue 6, March 18, 2016
Following up on the previous question's example of the therapy overpayment, would the agency also...
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Homecare Q&A, Issue 6, March 18, 2016
What potential impact does the final rule on overpayments have on home health agencies? For...
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Homecare Q&A, Issue 5, March 3, 2016
Since 1980, changes in the Medicare laws have added several circumstances that identify Medicare...
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Homecare E-News, Issue 8, February 22, 2016
The latest version of proposed cost reporting changes for the home health-based hospices...
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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...
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Homecare E-News, Issue 7, February 15, 2016
The Centers for Medicare & Medicaid Services (CMS) has issues a Change Request (CR) 9497. The...
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Homecare E-News, Issue 7, February 15, 2016
CMS intends to start a Medicare Probable Fraud Measurement Pilot for home healthcare services...
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Homecare E-News, Issue 6, February 8, 2016
The Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health...
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Homecare Q&A, Issue 2, January 18, 2016
One of our clients had overlapping visit times. The RN visited, provided skilled nursing care, and...
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Homecare E-News, Issue 51, December 28, 2015
CMS data shows cost disparities in home health services
Not unlike hospital procedures and tests...
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Homecare E-News, Issue 49, December 14, 2015
Although the final rule contained several notable changes to the proposed VBP pilot set to launch...
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Homecare E-News, Issue 48, December 7, 2015
On November 16, 2015, the Centers for Medicare & Medicaid Services (CMS) issued the final rule...
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Homecare E-News, Issue 48, December 7, 2015
The National Quality Forum (NQF) announced its plan to review standardized performance measure...
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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...
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Homecare E-News, Issue 47, November 30, 2015
The U.S. Department of Health and Human Services released its Agency Financial Report for fiscal...
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Homecare E-News, Issue 47, November 30, 2015
Assisted- and independent-living centers can be attractive places to do business for the home...
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Homecare E-News, Issue 46, November 23, 2015
Vets waiting, even dying, for home health care; telemedicine gains momentum
After the Inspector...
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Homecare E-News, Issue 44, November 9, 2015
On Monday, November 2, the Department of Health and Human Services (HHS) Office of Inspector...
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Homecare E-News, Issue 43, November 2, 2015
After receiving 118 comments from the public during the official comment period, the Centers for...
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Homecare E-News, Issue 43, November 2, 2015
Final Rule Released
After receiving 118 comments from the public, the Centers for Medicare &...
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Homecare E-News, Issue 41, October 19, 2015
Last Tuesday, NAHC submitted official comments to CMS on a pair of proposed clinical templates (one...
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Homecare Q&A, Issue 20, October 16, 2015
We are in disagreement about whether that is an appropriate frequency.
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Homecare E-News, Issue 39, October 5, 2015
This past Thursday (October 1, 2015), began the live implementation of ICD-10 across the...
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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...
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Homecare Q&A, Issue 19, October 2, 2015
We have been told that the following documentation would position us for a potential claim denial...
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Homecare Q&A, Issue 18, September 17, 2015
This patient’s change in condition has a real impact on resource utilization—an...
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Homecare Q&A, Issue 18, September 17, 2015
That documentation is not enough to translate into a billable skill. An example that would be...
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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...
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Homecare Q&A, Issue 17, September 8, 2015
The first event: The patient chooses to transfer from traditional Medicare to a Medicare Advantage...
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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...
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Homecare Q&A, Issue 15, August 3, 2015
Yes, Medicare will cover two visits if two individuals are needed to perform a covered service...
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Homecare Q&A, Issue 15, August 3, 2015
Because this is therapy that an agency would provide if the equipment were available, the same...
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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...
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Homecare Q&A, Issue 15, August 3, 2015
Flushing a peripherally inserted central catheter (PICC) line does indeed require the skills of a...
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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...
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Homecare Q&A, Issue 15, August 3, 2015
You won’t find any mention in the Medicare coverage criteria about chronic or nonhealing...
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Homecare Q&A, Issue 15, August 3, 2015
Since 1997, venipuncture has not been a qualifying service for Medicare coverage. However, once the...
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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...
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Homecare Q&A, Issue 14, July 16, 2015
Yes, it’s true. You can find that requirement
in CMS Publication 100-2, Chapter...
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Homecare Q&A, Issue 14, July 16, 2015
The agency is required to supply all supplies
on the NRS list.
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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...
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Homecare Q&A, Issue 14, July 16, 2015
The only similar guidance found was according
to CMS’ OASIS Q&A:
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Homecare Q&A, Issue 14, July 16, 2015
Thanks for your question and commitment
to compliance. In cases where you learn
after the fact...
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Homecare Q&A, Issue 13, July 2, 2015
Occupational therapy cannot qualify a patient for coverage initially, but after the patient has had...
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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...
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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...
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Homecare Q&A, Issue 13, July 2, 2015
July 3, 2015
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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...
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Homecare Q&A, Issue 12, June 15, 2015
Q: We are seeing a patient with Alzheimer’s disease, who was hospitalized for advanced...
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Homecare Q&A, Issue 12, June 15, 2015
What about goals, rehabilitation potential, and discharge plans? What are some key points we need...
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Homecare Q&A, Issue 12, June 15, 2015
What is the proper way to enter in orders for disciplines and treatments on the 485?
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Homecare Q&A, Issue 12, June 15, 2015
Assignment of benefits - This term means that the facility or the physician agrees to accept...
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Homecare Q&A, Issue 11, June 3, 2015
A clinician arrives at the home, where skilled services are provided. Based on the...
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Homecare Q&A, Issue 10, May 17, 2015
Can we use “zero” as a frequency in writing physician orders? For example, physical...
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Homecare Q&A, Issue 9, May 3, 2015
What should you do about a tardy recertification assessment? It’s the fifth day of the...
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Homecare Q&A, Issue 9, May 3, 2015
How do we get paid when we have two different payers—traditional Medicare (Part A) and...
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Homecare Q&A, Issue 9, May 3, 2015
What happens to patients who can self-inject but cannot pre-fill insulin syringes?
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Homecare Q&A, Issue 9, May 3, 2015
When does Medicare consider a wound as chronic/nonhealing and no longer pay for services?
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Homecare Q&A, Issue 9, May 3, 2015
What would be the response for M0150, Current Payment Sources, for an MA patient?
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Homecare Q&A, Issue 8, April 17, 2015
The final rule, and the corresponding correction that CMS put out regarding the therapy...
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Homecare Q&A, Issue 7, April 3, 2015
All Medicare patients for whom you bill, regardless of whether they are LUPA, require a...
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Homecare Q&A, Issue 7, April 3, 2015
Before offering the Medicare Hospice Benefit (MHB) to a beneficiary, the hospice must first verify...
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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...
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Homecare Q&A, Issue 6, March 17, 2015
Yes, all Medicare, Medicare Advantage, and Medicaid OASIS assessments must be transmitted.
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Homecare Insider, Issue 1, January 5, 2015
Will home health remain exempt from overtime compensation in most circumstances like it has for 40...