Hospice and Home Health Regulations Blog

For those of you who attended my regulatory update at the HEALTHCAREfirst Users Conference in San Antonio, one of the topics discussed were recent F2F clarifications and CMS’ intention to issue additional clarifications in a MedLearn Matters article targeted to physicians.

CMS has now published this as, “A Physician’s Guide to Medicare’s Home Health Certification, including the Face-to-Face Encounter.”  We recommend making sure the physicians you work with have this guidance.

Some of the items discussed in the Medlearn Matters guide include:

• Physician Home Health Certification Requirements remain the same.  
• Reminders regarding timeframe for completion of the certification and certification content reminders.
• Descriptions of physicians and NPPs who may perform a face-to-face encounter are now more detailed and are as follows:

Medicare-enrolled physicians who are also the certifying physician;
The following physicians are allowed to perform the face-to-face encounter and inform the certifying physician:

• Physicians (Medicare-enrolled or otherwise) who cared for the patient in an acute or post-acute facility during a recent acute or post-acute stay and have privileges at the facility;

Starting October 1, 2012, Home Health and Hospice agencies will be required to use occurrence code 55 to indicate a date of death on claims.

Occurrence code 55 and the date of death must be present when the following patient discharge status codes are used:

• 20 (expired) Home Health Only
• 40 (expired at home)
• 41 (expired in a medical facility)
• 42 (expired – place unknown)

Medicare will implement claims edits to ensure that occurrence code 55 is present in the above scenarios with dates of service on or after Oct 1, 2012.

HEALTHCAREfirst will post a reminder in September for recipients of the blog and will send providers using HEALTHCAREfirst software information about billing checks implemented to assist with these changes.

Click here to view the full Change request

CMS published a proposed rule today that would:

• Establish a unique health plan identifier (HPID) under Health Insurance Portability and Accountability Act of 1996 (HIPAA) standards for electronic health care transactions.  CMS states this change would save the health care industry up to $4.6 billion over ten years by enabling greater automation of electronic health care transactions, in turn helping physicians spend less time interacting with health plans — and more time with patients.
• Adopt a data element that would serve as an “other entity” identifier (OEID) for entities that are not health plans, health care providers, or individuals, but that need to be identified in standard transactions. The rule proposes an addition to the National Provider Identifier (NPI) requirements.

Participate in HH-CAHPS Now to Avoid Payment Reductions

Agencies using HEALTHCAREfirst can use the HH CAHPS data export feature and reporting tools to generate and review submission files.  HEALTHCAREfirst’s approved vendor list can be accessed here.

The Centers for Medicare & Medicaid Services (CMS) will begin publicly reporting results from the Home Health Care CAHPS (HHCAHPS) Survey on or after April 19, 2012. Medicare-certified home health agencies (HHAs) will be able to “preview” their results via a Preview Report, which will be posted on the HHCAHPS Web site on April 3, 2012.

Click here to see some questions and answers about the Preview Reports. More information about the results that will be publicly reported will be posted on the HHCAHPS Web site on April 3, 2012.

MLN Matters article reminds all HHAs of the requirement to participate in the Home Health Care CAHPS (HHCAHPS) survey for patients served in April 2012 and after to be eligible for the full market basket payment increase for calendar year (CY) 2014.

Announcement to Home Health and Hospice providers, CMS Enforcement Action Extended for 5010A1 and D.0 Compliance to June 30, 2012. Even though it has been delayed again, HEALTHCAREfirst supports 5010

(March 15, 2012) The Centers for Medicare & Medicaid Services’ Office of E-Health Standards and Services (OESS) is announcing that it will not initiate enforcement action for an additional three (3) months, through June 30, 2012, against any covered entity that is required to comply with the updated transactions standards adopted under the Health Insurance Portability and Accountability Act of 1996 (HIPAA): ASC X12 Version 5010 and NCPDP Versions D.0 and 3.0.

On November 17, 2011, OESS announced that, for a 90-day period, it would not initiate enforcement action against any covered entity that was not compliant with the updated versions of the standards by the January 1, 2012 compliance date.  This was referred to as enforcement discretion, and during this period, covered entities were encouraged to complete outstanding implementation activities including software installation, testing and training.

The Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced on February 16, 2012, that the HHS intends to delay the compliance date for ICD-10. The compliance deadline presently stands at October 1, 2013 (which is already a two-year delay from the original date outlined in the January 2009 final rule).

With no new declaration date, this new release suggests that HHS is paying very close attention to home care and hospice providers, medical billing companies, and others with a stake in the healthcare industry. Many healthcare providers have serious concerns about the administrative burdens that ICD-10 compliance may bring in the years ahead. The press release link is below.

It's that time of year again. A time I wish I could be like Samantha from the famous 60's TV show “Bewitched” and blink our cost reports away… or blink them completed.  Alas, as much as I long to have Samantha's power, no amount of nose twitching or eye-blinking will help right now. And so we proceed into the data collection & documentation phase of completing the cost report.

This is a time when many are preparing data for the submission of their cost reports.  Cost Reports are generally due at the end of the fifth month following the end of an agency's fiscal year.  That being said, if your fiscal year didn't conclude on December 31 you may not need to concern yourself with working on the cost report, just yet.

CMS utilizes the PS&R (Provider Statistical and Reimbursement System) for providing information to a variety of organizations; specifically Home Health & Hospice providers.  

Starting in July, hospices will be required to discontinue use of occurrence code 42 when a provider initiates the termination of hospice care and for hospices to only use occurrence code 42 to indicate a discharge due to a patient revocation. Hospices must also begin to use the new condition code to indicate a discharge due to the patient’s unavailability/inability to receive hospice services from the hospice which has been responsible for the patient.

Medicare will begin returning hospice claims that meet the following criteria with dates of service on or after July 1, 2012:

• Both condition code 52 and condition code H2 are present;
• Condition code 52 is present and the patient status code is 30;
• Condition code H2 is present and the patient status code is 30;
• Condition code H2 is present with occurrence code 42; or
• Condition code 52 is present with occurrence code 42.

THE HEAT IS ON

The Health Care Fraud Prevention and Enforcement Action Team (HEAT) has created free videos and audio podcasts (averaging about four minutes each) that cover major health care fraud and abuse laws, the basics of health care compliance programs, and what to do when a compliance issue arises. The first educational presentation was posted on the OIG website the week of December 5; 8 videos are currently accessible and the remaining 3 will be posted in the next few weeks: http://oig.hhs.gov/newsroom/video/2011/heat_modules.asp

The Office of Inspector General (OIG) identified 7 fundamental elements to an effective compliance program:

Important HH CAHPS Reminders

• Agencies who served 59 or fewer eligible patients between 4/1/10 and 3/31/11 must submit their exemption request forms by 1/21/2012 for 2013 CY HH CAHPS.
• All CAHPS vendors must submit 3^rd quarter 2011 data by 1/23/12 by 11:59PM. Home Health Agencies that have not already done so, should submit data to their CAHPS vendor to guarantee data is submitted to CMS before the deadline. Agencies using HEALTHCAREfirst can use the HH CAHPS data export feature and reporting tools to generate and review submission files.  HEALTHCAREfirst’s approved vendor list can be accessed here.

CMS reminded agencies in the recent Open Door Forum, that they should be checking their Data Submission Report on a regular basis to ensure their CAHPS vendor is submitting survey data before the submission deadline.  HHAs can access the Data Submission Report using these instructions: