Monday Minute with Melinda

Updated G-Codes Relating to Telehealth and Billing Non-Routine Supplies in Home Health (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: December 6, 2022

This Monday Minute discusses Telehealth G-codes effective January 1, 2023 and billing Non-Routine Supplies.

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Monday Minute with Melinda

Coding Changes for Home Health Related to the PDGM Model (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: November 28, 2022

In this Monday Minute, we will discuss specific coding changes related to the PDGM model for Home Health.

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Monday Minute with Melinda

Reviewing Home Health Value-Based Purchasing Pre-Implementation (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: November 21, 2022

In this week’s Monday Minute, we will review the Home Health Final Rule regarding Value-Based Purchasing that is set to begin in January 2023.

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Common Questions About Face-to-Face Under PDGM

By Robbi D. Funderburk James, BSN, RN, HCS-D, HCS-O / Posted on: November 17, 2022

Find out what is expected to be included in the documentation for home health cases under PDGM, Face-to-Face, and how that coding affects reimbursement.

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Monday Minute with Melinda

Medicare Open Enrollment and its Impact on Home Health and Hospice (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: November 14, 2022

This Monday Minute discusses the Medicare Open Enrollment period and how that impacts both Home Health and Hospice agencies.

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Monday Minute with Melinda

Reviewing the 2023 Home Health Final Rule (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: November 7, 2022

In this Monday Minute, we review the 2023 Home Health Final Rule that was released on October 31, 2022.

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Monday Minute with Melinda

HHCAHPS Survey Impact on the Value-Based Purchasing Model (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: October 31, 2022

This week’s Monday Minute discusses the HHCAHPS survey’s impact on the Value-Based Purchasing model that will begin on January 1, 2023.

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Monday Minute with Melinda

2023 Update on the VBID Model’s Hospice Component (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: October 24, 2022

In this Monday Minute, we discuss the recent 2023 information related to the Hospice component of the Value-Based Insurance Design (VBID) Model.

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Monday Minute with Melinda

Department of Health and Human Services Extends Public Health Emergency to January 11, 2023 (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: October 17, 2022

In this week’s Monday Minute, we discuss the announcement made by the Department of Health and Human Services that the Public Health Emergency has been extended for an additional 90 days.

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Monday Minute with Melinda

Implementation of OASIS-E and High Level Changes to the Data Set (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: October 10, 2022

This Monday Minute reviews highlights of the instruction for completion of some of the new items in OASIS-E and other changes to the Data Set.

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Monday Minute with Melinda

Hospice New Rates 2023, ICD-10 Codes Updated & PDGM Proposed (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: October 3, 2022

In this Monday Minute, we discuss the many changes that have gone into effect beginning on October 1, 2022 for Hospice and Home Health.

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Monday Minute with Melinda

Medical Review and Plan for the Next Visit Documentation (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: September 26, 2022

This Monday Minute discusses the requirements of documenting the true plan for the next visit on individual visit notes and what consequences will be paid under Medical Review when not accurately documented.

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Monday Minute with Melinda

How QAPI Processes Can Support Improvement in Home Health Value-Based Purchasing (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: September 19, 2022

In this Minute, we will discuss the updated fact sheet related to the Public Health Emergency for the status of waivers for both home health and hospice individually.

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Monday Minute with Melinda

Telehealth Used for Face-to-Face to Extend Beyond Termination of the Public Health Emergency (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: September 12, 2022

In this Minute, we will discuss the updated fact sheet related to the Public Health Emergency for the status of waivers for both home health and hospice individually.

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Monday Minute with Melinda

Clarifying Requirements for Coding and the Face-to-Face Encounter (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: September 5, 2022

In this Monday Minute, we will discuss a question that frequently comes up when discussing coding and the Face-to-Face encounter, especially under Medical Review.

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Monday Minute with Melinda

Two Important Updates for Outcome Measures and Data Reporting for Hospice (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: August 29, 2022

This Minute will highlight two important outcome measures and data reporting that will be incorporated into the Care Compare site for Hospice.

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Targeted Probe and Educate 101: What You Need to Know (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: August 22, 2022

Targeted Probe and Educate is a major issue that makes Home Health and Hospice agencies anxious. This video covers the process of Targeted Probe and Educate, what happens when you fail a review, and how to prevent it.

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Monday Minute with Melinda

Advocacy Needed to Preserve Access to Home Health (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: August 15, 2022

This Minute is to spark needed advocacy on behalf of home health agencies nationwide to stop the reduction of home health rates that were proposed by CMS.

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Home Health Value-Based Purchasing Program Nationwide Expansion

By Melinda A. Gaboury, CEO / Posted on: August 11, 2022

The expanded Home Health Value-Based Purchasing Model will use benchmarks, achievement thresholds, and improvement thresholds, based on baseline year data, to calculate achievement and improvement of Home Health Agency performance on quality measures.

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Monday Minute with Melinda

Review Choice Demonstration Cycle Selection Update (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: August 8, 2022

This Minute reviews the current cycles and upcoming selection dates in some states.

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Monday Minute with Melinda

2023 Hospice Final Payment Rule (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: August 1, 2022

This session will review the key highlights from the 2023 Hospice Final Rule. Payment rates have increased, the Hospice Cap is set and the HOPE is looking for Beta testers. Don’t miss it!

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Monday Minute with Melinda

OASIS-E Highlighted Changes (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: July 25, 2022

This Minute will review, at a very high level, some significant changes involved with OASIS-E implementation.

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Monday Minute with Melinda

2022 Home Health PEPPER Update (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: July 18, 2022

This Minute will review highlights of the July 2022 release of the updated PEPPER.

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Monday Minute with Melinda

CAHPS Hospice Survey Impact (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: July 11, 2022

This Minute will discuss thoughts surrounding the impact that field staff have on the results of the CAHPS Hospice Survey.

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Monday Minute with Melinda

2023 Home Health Proposed Payment Rule (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: July 4, 2022

This Minute will do a high-level review of the reimbursement and Value-Based Purchasing proposed changes for 2023.

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Monday Minute with Melinda

Clarification on Hospice Transfers (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: June 24, 2022

This Minute will review the clarification that CMS is providing regarding the fact that Hospice transfers cannot have a break in days in billing.

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Monday Minute with Melinda

Transmittal Regarding NPP Oversite has been Rescinded (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: June 17, 2022

This Minute will review the requirement that CMS tried to implement regarding collaboration with physicians when a NPP is certifying and/or signing home health orders and the result of the challenge, in the original transmittal being rescinded.

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Monday Minute with Melinda

OASIS-E Implementation is Imminent! (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: June 10, 2022

This Minute will provide a high-level overview of the release of the OASIS E Guidance Manual and the significance of starting education NOW!

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Monday Minute with Melinda

Detail Review of Hospice PEPPER Content (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: June 2, 2022

This Minute will review some of the detail content of the Hospice PEPPER, specifically the newly added PEPPER targets.

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Monday Minute with Melinda

Hospice Targeted Probe & Educate Update (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: May 27, 2022

This Minute will review some of the current activity with hospice scrutiny in Targeted Probe & Educate. We have seen a huge influx of medical review focused specifically on hospice, which includes Targeted Probe and Educate, since September 2021.

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Monday Minute with Melinda

Value Based Purchasing Benchmarks & Achievement Thresholds (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: May 24, 2022

This minute reviews details surrounding the release of the baseline year benchmarks and achievement thresholds.

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Monday Minute with Melinda

Home Health Claims & NOA Errors that Continue to Plague Agencies (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: May 5, 2022

This Monday Minute reviews current claims processing issues and highlights of the penalty exception requests process.

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Monday Minute with Melinda

Sequestration is BACK! (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: May 5, 2022

This Monday Minute will review the sequestration deduction that is once again being applied to all Medicare payments.

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Monday Minute with Melinda

Brief Announcement Regarding Medicare Advantage (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: May 2, 2022

This Monday Minute will briefly review the recent CMS rule regarding cost-sharing and the phases of VBID preparation for 2023.

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Monday Minute with Melinda

Diagnosis Coding Update for April 1, 2022 (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: April 25, 2022

This Monday Minute will briefly review the new ICD-10 Diagnoses related to COVID Vaccinations.

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Monday Minute with Melinda

Value Based Purchasing – Impact of OASIS Items (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: April 14, 2022

This Monday Minute will take you through some of the key components of OASIS and the impact they have on the Value Based Purchasing outcome measures.

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Monday Minute with Melinda

2023 Hospice Proposed Rule Recap (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: April 11, 2022

This Monday Minute will begin unfolding the important content of the Hospice Proposed Rule for 2023.

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PEPPER Reports 101: What You Need to Know (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: April 4, 2022

In this video, we will go in detail about what PEPPER Reports are and what they entail.

Industry educator, Melinda A. Gaboury, discusses the importance of PEPPER Reporting for your agency and how it relates to medical review. It’s imperative that someone within your organization immediately obtains access to the PEPPER Reports and begins to analyze exactly where your agency stands.

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Monday Minute with Melinda

HHCAHPS Impact on Value Based Purchasing & the Exemption Deadline (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: March 28, 2022

This Monday Minute will highlight the deadline for HHCAHPS Participation Exemption and review the impact that the HHCAHPS results will have on Value Based Purchasing as it is rolled out in January 2023.

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Monday Minute with Melinda

Home Health Value Based Purchasing – Rollout 2023 (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: March 21, 2022

This Monday Minute will touch on the highlights of the nationwide implementation of Home Health Value Based Purchasing, effective 1/1/2023.

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Monday Minute with Melinda

Hospice Certificate of Terminal Illness (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: March 14, 2022

This Monday Minute reviews the requirement of the certifying physician to create a clinical narrative, specific to the patient, as a part of hospice certification.

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Monday Minute with Melinda

OASIS-E – Coming January 2023 (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: March 7, 2022

This Monday Minute will provide a reminder about the swift approaching implementation of OASIS-E.

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Monday Minute with Melinda

OIG Report Released Regarding NonHospice Payments While Patients are on Hospice Services (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: February 28, 2022

This Monday Minute will review the OIG Report and what it possibly means for the future of Hospice Medical Review Audits & Investigations.

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Monday Minute with Melinda

Help Stop Sequestration through Advocacy Lead by the National Association for Home Care & Hospice (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: February 21, 2022

This Monday Minute provides encouragement for agencies to assist in advocacy regarding the sequestration deduction that is soon to be reinstated.

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Monday Minute with Melinda

Update on the Notice of Admission NOA 2022 (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: February 14, 2022

This Monday Minute will review the confirmed requirement that all home care agencies will have to request exception on ALL late NOAs, even if it was a MAC claims processing system error.

We will provide the links to the Medicare MAC websites, specifically to the claims processing logs.

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Monday Minute with Melinda

Care Compare January 2022 Refresh for HHQRP

By Melinda A. Gaboury, CEO / Posted on: February 7, 2022

This Monday Minute will take you through the highlights of the January 2022 Care Compare refresh of data.

We will provide a link to the updated Tips Report which gives you all of the information discussed in this minute plus more.

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Monday Minute with Melinda

Telehealth During the Continuing Public Health Emergency (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: January 31, 2022

This Monday Minute navigates the details of what can and can not be done regarding Telehealth during the current Public Health Emergency.

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Monday Minute with Melinda

Public Health Emergency Extension (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: January 24, 2022

This Monday Minute will highlight the issues related to the Public Health Emergency as it impacts home health and hospice waivers.

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Monday Minute with Melinda

Compliance with the Hospice Quality Reporting Program (HQRP) (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: January 17, 2022

This Monday Minute reviews the two components of the HQRP that impact the hospice reimbursement, if noncompliant.

There are two portions to the Hospice Quality Reporting Program. One is related to the CAHPS Hospice Survey participation, and the other is related to the HIS transmission requirement and today we will look into both.

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Monday Minute with Melinda

The NOA Kicks 2022 off with a Bang! (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: January 10, 2022

This Monday Minute reviews the current situation with the Notice of Admission and some key thoughts about moving forward.

The Medicare Home Health Notice of Admission has been what some would call a nightmare. All three of the Medicare MACs have had some level of issue with correct processing.

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Monday Minute with Melinda

VBID Awareness as Hospice enters 2022 (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: January 3, 2022

This Monday Minute will touch some very key points for Hospices in regard to the VBID demonstration.

The VBID demonstration started, of course in 2021, and will continue in 2022 into phase two. With 2022 beginning there are going to be several Medicare Advantage Plans added to the VBID model.

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Monday Minute with Melinda

NOA, Hospice Medical Review & Sequestration is Back! (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: December 27, 2021

This Monday Minute will review the TOP concerns moving into 2022, including the sequestration deductions beginning again. We want to share with you a couple of things on the three most important transitional things as we move into 2022 for both Home Health and Hospice.

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Notice Of Admission: The Lowdown On The Request For Anticipated Payment’s Successor

By Melinda A. Gaboury, CEO / Posted on: December 15, 2021

Do you have questions about the transition from Request for Anticipated Payment to Notice of Admission in 2022? This article will detail what is the same, what is different, and how to navigate the crossover periods. The RAP has been a part of home health for more than two decades. It may be hard for some to see it be retired, but there will be others who are going to celebrate. The NOA will boldly make its presence known in 2022 and hopefully bring some relief from the anxiety of the RAP requirements every 30 days.

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Monday Minute with Melinda

Notice of Admission 2022: EMR Failures (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: December 13, 2021

This Monday Minute will review the critical aspects of the Notice of Admission that includes the cross-over periods from 2021 and the necessity of access to the Direct Data Entry (DDE) system.

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Monday Minute with Melinda

Home Health & Hospice Quality Reporting Programs (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: December 6, 2021

This Monday Minute will review the reality that the Home Health and Hospice Quality Reporting Program requirements were reinstated with penalties as of July 1, 2020. We will review the deadlines, what is included in those, and the penalties that will be assessed if you are not compliant.

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Monday Minute with Melinda

NEW GG Item Education for OASIS Completion (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: November 15, 2021

This Monday Minute assists in making agencies aware of the new GG Item Education that CMS has published on their website for OASIS completion. We have provided a link to this new education and hopefully, you’ll find it very useful in the training of your staff specific to the GG Items in the OASIS documentation.

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Monday Minute with Melinda

2022 Home Health Final Rule Includes DELAY in VBP (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: November 8, 2021

This Monday Minute will review the 2022 Home Health Final Rule highlights, including the exciting announcement that Value Based Purchasing will be delayed until 2023. With this nationwide rollout being put off until January 2023, CMS is allowing for agencies to receive additional education to be able to figure out exactly how this Value Based Purchasing process works and be able to more fully understand how your agency can be successful under the Value Based Purchasing Model.

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Monday Minute with Melinda

Value-Based Insurance Design (VBID) Model: Hospice and Medicare Advantage in 2022 (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: November 2, 2021

This Monday Minute will take you through a brief update on the 2022 VBID model, which includes Hospice in the Medicare Advantage Organization plans that have volunteered to participate in the VBID demonstration.

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Monday Minute with Melinda

The Extension of the Public Health Emergency (PHE) (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: October 25, 2021

This Monday Minute will review the extension of the Federal Public Health Emergency, share some concerns that may impact agencies at the state level and some very important things to note regarding this extension of the PHE. It was set to expire in October of 2021 but now has been extended to the third week of January of 2022.

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Monday Minute with Melinda

Local Coverage Determinations (LCD) (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: October 18, 2021

This Monday Minute reminds home health and hospice about the significance that the LCD can have in the medical review of Medicare charts. We want to remind you about a very important document that the Medicare MACs have developed to help assist agencies in understanding the expectation of your medical record documentation.

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Monday Minute with Melinda

The Impact of Hurricane Ida

By Melinda A. Gaboury, CEO / Posted on: October 11, 2021

This Monday Minute will touch on the impact that Hurricane Ida has had on home health and hospice and exceptions granted by CMS to this area.

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Monday Minute with Melinda

Medicare Claims Processing Issues Logs (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: October 4, 2021

This Monday Minute emphasizes the importance of reconciling payments to your AR and the significance of the Medicare MAC claims processing issues logs.

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Hospice and Home Health PEPPER Reports (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: September 27, 2021

This Monday Minute discusses the impact that PEPPER Reports can have on a Home Care or Hospice agency. We also share the information needed to access your agency’s PEPPER Reports and when these reports are released annually.

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Medicare Eligibility Verifications (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: September 20, 2021

This Monday Minute will touch on the significance of Medicare Eligibility Verifications and a key update to the content of Workers’ Comp and Liability Policies in the Common Working File. We will point out something that we have discovered, that could be a significant help in situations where you do that Eligibility Verification, so watch to learn more about Medicare Eligibility Verifications to have a successful enrollment.

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Phase 4 Provider Relief Funds and 60-day Grace Period (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: September 13, 2021

This Monday Minute reviews the content of the HHS announcement regarding the, now available, $25.5 billion in additional provider relief funds. 8 billion of this money is to be given to small providers primarily in rural areas and bonuses will be given to providers that serve primarily Medicaid, CHIP and/or Medicare patients.

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Implementation of the Notice of Admission (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: September 7, 2021

This Monday Minute will take you through the key elements of the coming Notice of Admission and provide references. We want to share with you a document that was published by Palmetto GBA, CGS and NGS, all three of the Home Health Medicare MAC’s this past week. This document goes through the details of what is going to be included in the Notice of Admission, beginning January 1st of 2022.

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Case-Mix Weight Changes in the HH Proposed Rule 2022 (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: August 27, 2021

This Monday Minute provides thoughts about the potential impact of the proposed case-mix weight changes on overall reimbursement in 2022.

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Home Health Care and Home Infusion Therapy Benefit

By Sharon Litwin, RN, MHA, HCS-D / Posted on: August 24, 2021

This article will detail eligibility requirements for Medicare home health patients—homebound, face-to-face, skilled need—and will discuss the new payment model, the Patient-Driven Groupings Model (PDGM). The article also includes case scenarios for home health patients that require IV therapy as well as other home health interventions for various disease processes and the Medicare Home Health Benefit and the HIT Benefit intertwine.

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Value Based Purchasing Nationwide Rollout 2022 (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: August 20, 2021

This Minute briefly reviews some of the highlights of Value Based Purchasing and what has been proposed. Value-Based purchasing has been proposed in the form of a nationwide rollout for home health beginning in January 2022.

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Targeted Probe & Educate: Here We Go Again! (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: August 13, 2021

This Minute will take you through a quick recap of the Targeted Probe & Educate framework as the program is being reinstated!

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Proposed CoP Changes that Need Your Feedback (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: August 9, 2021

This Minute reviews the four items that are being proposed for change in the Home Health Conditions of Participation, specific to home health aide supervision. Make sure to stay tuned for more updates!

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2022 Hospice Final Rule Released (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: August 2, 2021

This minute covers a quick recap of The Hospice Final Rule released on July 29, 2021 that updates Medicare hospice payments and the aggregate cap amount for FY 2022 in accordance with existing statutory and regulatory requirements. Make sure to stay tuned for more updates!

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Review Choice Demonstration Update (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: July 26, 2021

This minute covers the update for Florida and North Carolina Home Health Review Choice Demonstration (RCD). Palmetto GBA provides HHAs with a wealth of information addressing the requirements and expectations of the RCD. Make sure to stay tuned!

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Hospice Survey Changes in the Home Health Proposed Rule (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: July 19, 2021

This minute is to make you aware that there are tons of pages in the 2022 Proposed Home Health Rule that are specific to Hospice. HPS will also have upcoming material that will discuss these updates. Make sure to stay tuned!

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More Details on the 2022 Home Health Proposed Rule (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: July 12, 2021

This minute covers more details on the 2022 Home Health Proposed Rule. Register for our June15th webinar for more in depth information. Make sure to stay tuned!

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The Home Health Proposed Rule 2022 (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: July 6, 2021

This minute covers some of the changes for the Home Health Proposed Rule that were released on June 21st. Make sure to stay tuned!

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OSHA Emergency Temporary Standard (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: June 28, 2021

This minute covers the COVID-19 Healthcare ETS (Emergency Temporary Standard) being officially filed in the Office of the Federal Register on June 17, 2021, and it became effective when it was published on June 21, 2021. Make sure to stay tuned!

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Provider Relief Funds Reporting Update (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: June 21, 2021

This minute covers the HHS revision of the Post-Payment Notice of Reporting Requirements as of June 11, 2021. This new version supersedes all previous versions of the Post-Payment Notice of Reporting Requirements documents. Make sure to stay tuned!

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Increase in COVID-19 Vaccine Administration Payments (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: June 14, 2021

This minute covers the news release from CMS concerning: Medicare Billing for COVID-19 Vaccine Shot Administration. Effective June 8 of 2021, CMS has now approved that the COVID vaccination administration payment is going to be $75 per shot, which is almost double what they had increased it to earlier this year. The emphasis on getting as many people vaccinated as we possibly can is apparent. Make sure to stay tuned!

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Post Payment Reviews Inside the Public Health Emergency (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: June 7, 2021

This minute covers the news release from CMS concerning, MACs Resume Medical Review on a Post-payment Basis. Beginning August 2020, Medicare Administrative Contractors (MACs) resumed post-payment reviews of items and services with dates of service before March 2020. MACs may now begin conducting post-payment medical reviews for later dates of service. Make sure to stay tuned!

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Home Health Value-Based Purchasing Annual Report (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: June 1, 2021

This Minute covers a review of the Home Health Value-Based Purchasing (HHVBP) Model – Fourth Annual Report. Make sure to stay tuned!

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Emergency Preparedness Update (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: May 24, 2021

Today’s video clip covers the Updated Guidance for Emergency Preparedness memo released in March of 2021. You need to thoroughly review all of the changes that have taken place in this update. Make sure to stay tuned!

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Notice of Admission Transmittal (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: May 17, 2021

This Minute covers the highlights of Transmittal 10758, dated May 11, 2021 with updates to the Medicare Claims Processing Manual regarding the NOA implementation for January 2022. Make sure to stay tuned!

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Emergency Preparedness UPDATE Blog

By Sharon Litwin, RN, MHA, HCS-D / Posted on: May 12, 2021

The Center for Clinical Standards and Quality/Quality, Safety & Oversight Group updated guidance for surveyors in QSO-21-15-ALL which revised emergency preparedness considering the Public Health Emergency (PHE). Emergency Preparedness (EP) takes a front seat with the Pandemic – CMS has revised the EP condition to add elements related to the Public Health Emergency (PHE) and the Pandemic.

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Hospice Proposed Rule Comments & Happy Nurse’s Month! (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: May 10, 2021

Welcome to Monday Minute with Melinda! This Minute highlights some very key components of the Hospice Proposed Rule that needs your feedback. Make sure to stay tuned!

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The HEAT Act (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: May 3, 2021

Welcome to Monday Minute with Melinda! This Minute is a call to action regarding the Senate bill the HEAT Act. Please review and participate. Make sure to stay tuned!

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COVID Vaccine Administration Billing Update & Extension of the Public Health Emergency (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: April 26, 2021

Welcome to Monday Minute with Melinda! This session reviews the details of the Condition Code that must be used in billing vaccine administration for Medicare Advantage enrolled patients. Additionally, we touch on the extension of the PHE and corresponding CMS Waivers. Make sure to stay tuned!

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FY2022 Hospice Proposed Payment Rule

By Leslie Heagy, RN, COS-C / Posted on: April 21, 2021

In addition to the proposed changes for hospice providers CMS included proposed changes to the Home Health Quality Reporting program (HH QRP) to resume in the reporting for January 2022. The proposed rule for hospice and home health QRP is summarized in today’s blog.

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Sequestration, Reminder Regarding NPPs in Home Health & Update on Claims Processing (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: April 19, 2021

Welcome to Monday Minute with Melinda! Welcome to Monday Minute with Melinda! This session is loaded with updates regarding sequestration, claims processing and the use of NPPs in Home Health. Make sure to stay tuned!

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Reporting From The Vaccine Frontline

By Sharon Litwin, RN, MHA, HCS-D / Posted on: April 14, 2021

“Hope is important because it can make the present moment less difficult to bear. If we believe that tomorrow will be better, we can bear a hardship today.” — Thich Nhat Hanh

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2022 Hospice Proposed Rule (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: April 12, 2021

Welcome to Monday Minute with Melinda! This video clip gives you some highlights of the just issued proposed rule and resources for obtaining details. Make sure to stay tuned!

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COVID-19 Coding Changes

By Sharon Litwin, RN, MHA, HCS-D / Posted on: April 8, 2021

It remains challenging to code COVID-19 for patients, as there are so many variations seen, especially as time goes on.   However, as of January 1, 2021, we have new diagnosis codes that are to be used for COVID-19 patients. They don’t include all of the patient scenarios for the conditions seen after COVID but it is a start.

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Medicare Regulatory Update (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: April 5, 2021

Welcome to Monday Minute with Melinda! This video clip will provides an update on Sequestration claims hold, Advanced & Accelerated Payments & Provider Relief Funds! Make sure to stay tuned!

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HPS Celebrates 20 Years of Success!

By Melinda A. Gaboury, CEO / Posted on: April 2, 2021

Today, April 2, 2021, HPS has reached an exciting milestone as we celebrate 20 years of business in Home Care and Hospice.

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Accelerated and Advance Payment Recoupment to Begin (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: March 29, 2021

Welcome to Monday Minute with Melinda! This video clip will recap the process of Medicare recouping the Accelerated and Advance Payments from 2020. Make sure to stay tuned!

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Value-Based Insurance Design (VBID) Model: Medicare Advantage – Hospice Carve-in

By Melinda A. Gaboury, CEO / Posted on: March 24, 2021

Medicare Advantage Value-Based Insurance Design (VBID) Model was developed for CMS to test a broad array of Medicare Advantage (MA) health plan innovations designed to reduce Medicare program expenditures, enhance the quality of care for Medicare beneficiaries, and improve the coordination and efficiency of health care service delivery. The goal is for the VBID Model to contribute to the modernization of MA and test whether these model components improve health outcomes and lower expenditures for MA enrollees.

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COVID-19 Vaccine Administration (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: March 22, 2021

Welcome to Monday Minute with Melinda! This week’s video clip will discuss the billing and reimbursement for COVID-19 Vaccine Administration. Make sure to stay tuned!

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OIG Conducting Audit on Telehealth (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: March 15, 2021

Welcome to Monday Minute with Melinda! This video clip will recap some of the documentation requirements for telehealth and the OIG audit to take place. Make sure to stay tuned!

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Revisions to Infection Control and Practices during COVID-19 PHE

By Sharon Litwin, RN, MHA, HCS-D / Posted on: March 10, 2021

The Center for Clinical Standards and Quality/Quality, Safety & Oversight Group released a QSO-21-08-NLTC (Non Long Term Care) on December 30, 2020 to State Survey Agency Directors. This QSO revised the COVID-19 Focused Infection Control (FIC) Survey Tool for Acute and Continuing Care, of which home health and hospice are a part.

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Hospice ADRs on the Rise! (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: March 8, 2021

Welcome to Monday Minute with Melinda! This week’s video clip will provide some key elements of responding to Hospice ADRs. Monday Minute with Melinda gives agencies the opportunity to receive critical weekly video updates, Make sure to stay tuned!

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Exceptions for Late RAPs! (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: March 1, 2021

Welcome to Monday Minute with Melinda! This week’s video offers quick tips on ensuring that you are coding appropriately for requesting an exception to a late RAP in 2021. Monday Minute with Melinda gives agencies the opportunity to receive critical weekly video updates, Make sure to stay tuned!

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Home Health Final Claim Clarification (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: February 24, 2021

Monday Minute with Melinda gives agencies the opportunity to receive critical weekly video updates. This week, Melinda highlights the most recent clarification for Medicare Home Health Billing of Final Claims in 2021. Help with cleaning out your Return to Provider Claims is just a click away!

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Implementation of Home Infusion Therapy services

By Sharon Litwin, RN, MHA, HCS-D / Posted on: February 18, 2021

The Home Infusion Therapy (HIT) benefit went into effect January 1, 2021. HIT services are excluded from coverage under the Medicare Home Health Benefit. If an agency has a home infusion pharmacy that is an accredited home infusion therapy supplier as well, they can now bill this service portion through the Part B benefit.

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Implementation of Hospice Item Set (HIS) V3.00 & Hospice Quality Reporting Program (HQRP) Reporting Reminders

By Leslie Heagy, RN, COS-C / Posted on: January 20, 2021

The Hospice Quality Reporting Program (HQRP) webpage released an Important Update on 12/31/20 regarding the implementation of the Hospice Item Set (HIS) version V3.00 specifications. The Update stated that on January 1, 2021, CMS will move forward with the implementation of V3.00 of the HIS data submission specifications.

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Wrap Your Arms Around the RAP – Request for Anticipated Payment 2021

By Melinda A. Gaboury, CEO / Posted on: December 29, 2020

Beginning 1/1/2021 the Request for Anticipated Payment (RAP) will no longer have a 20% payment associated with its processing. The RAP will continue to be a requirement for payment and ironically will be associated with a penalty if it is not accepted at the Medicare Administrative Contractor (MAC) by Day 5, the begin date of the payment period being Day 0. The penalty will be a daily amount as a proportion of the 30-day value related to the HIPPS code that the 30-day payment period is worth.

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HPS Acquires 5 Star Consultants to Expand Clinical Services, Coding & OASIS Review

By Melinda A. Gaboury, CEO / Posted on: October 1, 2020

We are extremely proud to welcome 5 Star Consultants’ industry-leading home care coding, OASIS review, and clinical consulting team to HPS. Together with their knowledge and experience, HPS is a stronger full-service home care and hospice resource for both current and new clients.

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2021 Hospice Final Payment Rule

By Leslie Heagy, RN, COS-C / Posted on: September 2, 2020

The Hospice FY2021 Final Wage Index and Payment Rate Update from CMS is summarized in this post with changes for Hospice providers. The new regulations will be effective on October 1, 2020. The overall economic impact of this final rule is estimated to be $540 million in increased payments to hospices for FY2021. HPS is working to keep Hospices informed of all the details related to the changes with the 2021 Final Rule.

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Home Health Proposed Payment Rule CY2021

By Melinda A. Gaboury, CEO / Posted on: August 3, 2020

CMS released the CY 2021 Home Health Proposed Payment Rule in June 2020. The proposed rule contains several updates and changes. These changes include PDGM Rates, Wage Index, Telehealth, Quality Reporting Program, and Billing RAPS. The RAP issue alone is enough to warrant EVERY agency in the nation sending in comments and requesting that this be changed! We must stand together.

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New Advanced Beneficiary Notice of Noncoverage (ABN) – Home Health and Hospice

By Leslie Heagy, RN, COS-C / Posted on: July 1, 2020

CMS announced the renewal of the Advanced Beneficiary Notice (ABN). The new ABN form is effective for use on or after August 31, 2020. Home Health and Hospice Providers need to ensure they are using the most current form. All Medicare Beneficiaries and Healthcare Providers have rights and are protected against financial liability through an Advanced Beneficiary Notice (ABN). Home Health providing care under Part A or Part B and Hospice providers under Part A are responsible for giving this notice to the beneficiary in situations where Medicare payment is expected to be denied.

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COVID-19: Interim Final Rule & What It Means for Home Health

By Melinda A. Gaboury, CEO / Posted on: May 14, 2020

There have been two Interim Final Rules, the most recent on May 1, that have been issued by CMS during this historic pandemic of the century. This Public Health Emergency (PHE) has taken the full focus of national officials and in the process, there have been sweeping concessions for healthcare, some permanent and others temporary.

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COVID-19: Emergency Financial Relief for Home Health & Hospice Providers

By Melinda A. Gaboury, CEO / Posted on: April 20, 2020

(UPDATED – 05/14/2020) The CMS Accelerated and Advance Payments Program program was suspended on April 26, 2020 and no further Accelerated Payments are happening at this time. During this Public Health Emergency (PHE) there are several avenues of obtaining cash to keep your agency going. This article addresses two of those. The Accelerated and Advance Payments Program allows agencies to get an advance on Medicare payments and it must be repaid. The other is the CARES Act Provider Relief Fund that is being automatically disbursed. Agencies will not need to repay these funds, however, there are accountability requirements for accepting and using these funds.

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COVID-19: Imperative Home Health and Hospice Updates

By Melinda A. Gaboury, CEO / Posted on: April 1, 2020

This article was last updated on May 7, 2020.

As we are facing the pandemic of the century, home health and hospices are on the frontline of this Public Health Emergency (PHE) along with hospitals, physicians and all other healthcare workers. We at Healthcare Provider Solutions, Inc. would like to take this moment to thank each and every one of you for your true dedication to treating patients and helping the world to be a healthier place. HPS is dedicated to providing the Home Health and Hospice industries with the education and resources necessary to keep you performing at the highest level of success.

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Hospice Targeted Probe and Educate – Avoid Claim Denials

By Leslie Heagy, RN, COS-C / Posted on: February 25, 2020

Targeted Probe and Educate (TPE) is continuing to be a problem for Hospice providers with some advancing to rounds 2 and 3 of the audit. This demonstration, which includes hospices receiving 20-40 claim requests for Additional Development Requests (ADR) in each round, have hospices wondering if they are going to be targeted next. In order to avoid advancing to the next round of TPE, the hospice’s calculated error percentage at the end of each round must be less than the percentage set by the MAC.

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PDGM Series: Top Five Ways to Avoid Losses!

By Melinda A. Gaboury, CEO / Posted on: February 11, 2020

Agencies across the nation are trying to figure out the best practices for being successful under PDGM. Explore the Top 5 things agencies should focus on to avoid significant losses under PDGM.

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Documenting Hospice Eligibility for a Cardiopulmonary Diagnosis

By Leslie Heagy, RN, COS-C / Posted on: February 4, 2020

When documenting hospice eligibility for a cardiopulmonary diagnosis you MUST go beyond the disease-specific LCD guidelines to avoid denial under medical review.  Many people who suffer from advanced cardiopulmonary disease share multiple symptoms as the disease progresses, however, the symptoms affect each patient differently and therefore, must be documented this way in order to support each patient’s terminal condition.

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PDGM Series: Functional Impairment Scoring & OASIS-D1

By Melinda A. Gaboury, CEO / Posted on: December 9, 2019

Preparing for PDGM: Step 3 in establishing a Home Health Resource Group (HHRG) and case-mix weight is patient Functional Impairment based on OASIS-D1 responses.

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PDGM Series: Understanding the First Steps in Patient Grouping—Admission Source and Timing

By Melinda A. Gaboury, CEO / Posted on: November 19, 2019

Transitioning to the Patient-Driven Groupings Model (PDGM) has already begun to impact operations for home health agencies that are indeed convinced that preparation should be underway. The first two pieces to the puzzle in establishing a Home Health Resource Group (HHRG) and corresponding case-mix weight are Admission Source and Timing. Both of these items are extremely important and will need meticulous attention at the Start of Care (SOC) and, for the Admission Source, that attention will need to continue into subsequent 30-day payment periods.

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PDGM Series: Top 25 PDGM Questions to Ask Your Home Health Agency’s Software Vendor

By Melinda A. Gaboury, CEO / Posted on: October 21, 2019

As home health agencies continue to plan for the implementation of PDGM there are some very important questions that agencies should be asking of the software vendors/electronic medical records (EMR) that will be utilized for clinical documentation and billing of Medicare Home Health claims.

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PDGM Series: Clinical Groupings & Comorbidity Adjustments

By Melinda A. Gaboury, CEO / Posted on: October 1, 2019

Transitioning to the Patient-Driven Groupings Model (PDGM) has already begun to impact operations for home health agencies that are indeed convinced that preparation must begin now.  Diagnosis coding and OASIS ADL data are two significant areas that the agency can impact by deeper education and understanding of both items.  Clinicians must understand the dire importance of including the appropriate disease processes in the assessment of the patient and development of care plans.

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FY2020 Hospice Final Rule: Changes to Hospice Reimbursement

By Leslie Heagy, RN, COS-C / Posted on: September 10, 2019

The rule rebases the continuous home care, general inpatient care and the inpatient respite care per diem payment rates in a budget-neutral manner to more accurately align Medicare payments with the cost of providing care. In addition, the rule modifies the election statement by requiring an addendum that includes information aimed at increasing coverage transparency for patients under a hospice election. Finally, this rule includes changes to the Hospice Quality Reporting Program.

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PDGM Series: The 2020 Proposed Rule Update

By Melinda A. Gaboury, CEO / Posted on: August 27, 2019

January 1, 2020 will bring many new beginnings, including the Patient Driven Groupings Model (PDGM). No doubt the largest reimbursement system overhaul in home health since October 2000.
CMS continues to tweak the model and updates to the Claims Processing Manuals have begun.

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OASIS-D1 Update & PDGM Impact

By Melinda A. Gaboury, CEO / Posted on: July 1, 2019

CMS has announced that the revised OASIS-D1 instruments will be effective January 1, 2020. Changes to the OASIS-D data set and data collection guidance were finalized in the Calendar Year (CY) 2019 HH Final Rule, CMS 1689-FC.

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Targeted Probe & Educate (TPE): Top 5 Hospice Denial Reasons

By Melinda A. Gaboury, CEO / Posted on: May 30, 2019

As long as hospices are carefully documenting the details of each patient’s clinical situation and each patient meets the eligibility requirements for hospice care—these denials are avoidable. Don’t be the hospice that gets technical denials for careless mistakes, like incorrect format of the election statement or completing CTIs with boxed/canned statements that are not specific to the patient.

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8 Major Changes Outlined in the FY2020 Hospice Wage Index Update

By Leslie Heagy, RN, COS-C / Posted on: May 3, 2019

The FY2020 Hospice Wage Index & Payment Rate Update & HQRP Proposed Rule presents significant changes to rates and election statements. This proposed rule needs our full attention and comments! Please do your part and comment by the deadline stated in this article.

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Are You Prepared? The Patient Driven Groupings Model (PDGM) Is Coming Soon

By Melinda A. Gaboury, CEO / Posted on: April 30, 2019

Home health agencies may find many of the changes to OASIS-D daunting, but there are several modifications that have helped make assessments easier than ever before. The Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act) is the primary driving force behind the OASIS changes.

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Review Choice Demonstration Implementation Plan

By Melinda A. Gaboury, CEO / Posted on: April 3, 2019

The choice selection period for HHAs located in Illinois will begin on April 17, 2019 and end on May 16, 2019. Agencies in the other four targeted states; Ohio, North Carolina, Texas and Florida, should begin immediate preparation for RCD as it is imminent in your state!

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7 Best Practices and Tips for OASIS-D Compliance and Home Health Quality Assurance

By Melinda A. Gaboury, CEO / Posted on: April 2, 2019

Home health agencies may find many of the changes to OASIS-D daunting, but there are several modifications that have helped make assessments easier than ever before. The Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act) is the primary driving force behind the OASIS changes.

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Documenting Hospice Eligibility for Alzheimer’s Dementia

By Leslie Heagy, RN, COS-C / Posted on: March 22, 2019

When admitting a patient to hospice with a primary terminal diagnosis of Alzheimer’s disease, your documentation should clearly show the nature and condition causing the hospice admission in addition to, the hospice disease-specific LCD guidelines.

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The Review Choice Demonstration (RCD) Is Here!

By Melinda A. Gaboury, CEO / Posted on: March 13, 2019

The Office of Management & Budget (OMB) officially approved implementation of the Review Choice Demonstration in Home Health. Review Choice Demonstration (RCD) for Home Health Services will give providers in the demonstration states an initial choice of three options…

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Required Hospice GIP Documentation

By Leslie Heagy, RN, COS-C / Posted on: February 4, 2019

General Inpatient (GIP) Care is one of the four levels of care available to patients who elect the Medicare Hospice Benefit. When may GIP level of care be appropriate? When is it NOT appropriate to use GIP level of care?

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Agencies at Risk for Missing FIPS Codes

By Melinda A. Gaboury, CEO / Posted on: January 30, 2019

Home Health Agencies across the country are at risk for penalties and recouped claims if the FIPS code is NOT reported on ALL CLAIMS!

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New Hospice Comprehensive Assessment Measure added to Hospice Compare

By Leslie Heagy, RN, COS-C / Posted on: January 18, 2019

The NEW Hospice Comprehensive Assessment Measure takes these 7 individual measures and combines them into a single metric. This measure is an “all-or-none” measure, which means that in order to receive credit, the hospice must successfully complete ALL 7 care processes for which the patient is eligible.

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Hospice Item Added to OIG Work Plan – Protecting Medicare Hospice Beneficiaries from Harm

By Leslie Heagy, RN, COS-C / Posted on: January 2, 2019

The OIG released a hospice portfolio report Vulnerabilities in the Medicare Hospice Program Affect Quality Care and Program Integrity in July of 2018, identifying vulnerabilities in the Medicare Hospice Program and made 16 recommendations to CMS to strengthen the hospice program.

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2019 Rural Add-On Changes

By Melinda A. Gaboury, CEO / Posted on: November 30, 2018

As if the changes in the payment system were not enough. Based on the 2019 Medicare Home Health Final Rule, released in early November 2018, the Rural Add-On is being completely revised.

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OASIS-D: ARE YOU READY FOR 2019?

By Melinda A. Gaboury, CEO / Posted on: October 30, 2018

OASIS has indeed changed again and quite dramatically this time. While there are 28 M items that have been deleted from the data set and only 6 new ones added, don’t be fooled into believing that this will be a breeze.

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Top Denial Reasons – Hospice Targeted Probe and Educate

By Leslie Heagy, RN, COS-C / Posted on: September 11, 2018

Targeted Probe and Educate (TPE) is underway for Hospice Agencies. HPS is seeing many ADR denials with agencies moving to round 2 and 3 of TPE from both CGS and NGS.

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2019 Value Based Purchasing Proposed Changes (UPDATED)

By Melinda A. Gaboury, CEO / Posted on: August 27, 2018

The Centers for Medicare and Medicaid Service (CMS) finalized all of the proposed changes to the Value-Based Purchasing (VBP) Model for implementation January 1, 2019. One of the refinements of VBP removed five measures, while adding two new composite measures.

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2019 Home Health Proposed Payment Rule – PDGM 2020

By Melinda A. Gaboury, CEO / Posted on: August 8, 2018

The Centers for Medicare and Medicaid Service (CMS) released the CY2019 Medicare Home Health payment rule July 12, 2018. This proposed rule is voluminous and carries an immense number of proposed changes. HPS will continue analyzing and updating the proposed elements of this rule.

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Hospice HEART Update

By Katie Wehri / Posted on: July 30, 2018

The retooling of the Hospice Evaluation and Assessment Reporting Tool (HEART) is a significant development. CMS has been moving rather expeditiously on the HEART tool, and it is believed the tool is one of the key components necessary for future changes in hospice including payment refinement.

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Big Changes for Hospice Billing – MLN Matters SE18007

By Katie Wehri / Posted on: July 11, 2018

CMS recently released MLN Matters SE18007 which details recent and upcoming improvements to Medicare hospice billing. Two recent improvements – Electronic Submission of the Notice of Election (NOE) and Correcting Election or Revocation Dates using Occurrence Code 56 – are summarized and additional upcoming improvements are addressed.

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Diagnosis Coding for Home Care

Diagnosis Coding for Home Care – Tips for Success

By Sharon Litwin, RN, MHA, HCS-D / Posted on: July 2, 2018

As the first year of PDGM has unfolded there have been many twists and turns in the new complexity of coding in home care. Many of the diagnosis codes we had been utilizing in home health, are no longer allowed as a primary diagnosis, called unacceptable primary diagnoses. Coding has always been important in home care, but is increasingly being scrutinized. Stay ahead of the game and ensure that your coding is up to par.

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Hospice Utilization & Payment Public Use File

By Katie Wehri / Posted on: June 13, 2018

CMS is proposing to add Hospice Utilization and Payment Public Use File (Hospice PUF) data to Hospice Compare. The PUF data is derived primarily from hospice claims and the most current PUF data is from FY2015. The data would be in a segregated section of Compare as it contains information about hospice payments and utilization not quality measures.

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Pre-Claim Review Demonstration Coming Back?

By Melinda A. Gaboury, CEO / Posted on: June 7, 2018

CMS released a Comment Request, via the Federal Register, regarding Pre-Claim Review Demonstration being set to return on or after October 2018 in Illinois, Ohio, North Carolina, Florida, and Texas. The revised demonstration would last five years and Illinois will kick off the demonstration again and will be followed by Ohio and North Carolina and later Texas and Florida.

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OASIS D – What is on the Horizon?

By Melinda A. Gaboury, CEO / Posted on: May 15, 2018

OASIS D data set has been released as proposed and will be in the form of a final rule soon. There has not yet been a release of actual guidance in completing new items added to the OASIS D data set, but the items being removed and added has been proposed. We are providing information about the items removed and the new items added to the OASIS data set for 01/01/2019 implementation.

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Hospice FY2019 Proposed Rule – Payment and Quality Reporting Program

By Katie Wehri / Posted on: May 4, 2018

The FY 2019 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements proposed rule was recently made available. Of concern is the fact that CMS found 66% of hospice cost reports would have been rejected had certain edits been in place. Check back soon for future blog articles containing more detailed information about the quality reporting program updates and comments in the proposed rule.

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Hospice Quality Measure Reports Available

By Katie Wehri / Posted on: April 23, 2018

The Centers for Medicare and Medicaid Services (CMS) recently announced that corrections have been made to the hospice quality measure reports available in CASPER and are now ready for viewing. It has come to our attention that some hospices are not aware of these reports and are not accessing them and are missing out on valuable information. To get started with CASPER…

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Home Health MedPAC Report to Congress

By Katie Wehri / Posted on: April 13, 2018

Each year the Medicare Payment Advisory Commission (MedPAC) submits its annual report to Congress which contains information and recommendations related to Medicare fee-for-service (FFS) programs. This article details the 2018 annual report recommendations for Home Health.

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Hospice MedPAC Report to Congress

By Katie Wehri / Posted on: April 4, 2018

Each year the Medicare Payment Advisory Commission (MedPAC) submits its annual report to Congress which contains information and recommendations related to Medicare fee-for-service (FFS) programs. This article details the 2018 annual report recommendations for Hospice.

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Two Big Changes for Hospice

By Katie Wehri / Posted on: March 21, 2018

Recently, through the Bipartisan Budget Act of 2018 (Budget Act), Congress made changes directly impacting hospices. Hospices should review the changes and consider how the change will impact them and prepare accordingly. The first change…

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Targeted Probe and Educate – What We Have Learned So Far

By Melinda A. Gaboury, CEO / Posted on: March 13, 2018

Targeted Probe & Educate began on 10/1/17 and is full speed ahead. HPS has discovered nuances with TPE that we did not expect nor have we experienced in past ADR reviews. This review includes targeted medical review and education along with the potential of elevated action toward the agency. This elevated action could take place if the agency is not meeting the standards laid out by the Medicare MAC.

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CAHPS – Home Health & Hospice

By Melinda A. Gaboury, CEO / Posted on: March 2, 2018

Are you monitoring the agency’s CAHPS results? There are numerous questions on the survey that the patients must complete, but only selected ones go into the outcome measure calculations. Home Health CAHPS results have been reported on the Home Health Compare website for quite some time, while the results for the CAHPS Hospice Survey just began being public reported on Hospice Compare 02/22/18. One of the lowest scoring…

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Hospice Orientation and Training

By Katie Wehri / Posted on: February 19, 2018

There are more than 4,000 hospices in the United States. They serve approximately 1.5 million people, and their families. All staff members need to be trained, oriented to hospice and their role in delivering care. This article dives deep into the topic of Hospice orientation and training. We also provide the information necessary to succeed with the implementation of your program.

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HHCCN, ABN, NOMNC – Which Form Do I Use?

By Melinda A. Gaboury, CEO / Posted on: February 9, 2018

Home health providers may find themselves bombarded by forms and paperwork on a daily basis and find it difficult to remain compliant in utilizing the most up-to-date forms. This blog will briefly discuss the current versions of the Home Health Change of Care Notice (HHCCN), Notice of Medicare Non-coverage (NOMNC), and the Advance Beneficiary Notice (ABN) forms.

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When Must an Advance Beneficiary Notice Be Used in Hospice?

By Katie Wehri / Posted on: February 2, 2018

All Medicare and Medicare Advantage beneficiaries and providers have rights and are protected against financial liability through an Advance Beneficiary Notice (ABN). The provider is responsible for giving this notice to the beneficiary in certain instances. The ABN used by hospice providers is…

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Top Ten Hospice Survey Deficiencies

By Katie Wehri / Posted on: January 22, 2018

The top ten hospice Medicare certification/recertification survey deficiencies have remained fairly consistent for the past several years. This article contains the top ten list for 2017. For calendar year 2017, nine of the top ten deficiencies were the same as in calendar year 2016 – with L531 coming on the list at number ten and L591.

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Home Health & Hospice PEPPER Reports

By Melinda A. Gaboury, CEO / Posted on: January 15, 2018

Over the past couple of years, HPS has reported and discussed that Home Health and Hospice PEPPER Reports are very important and should be reviewed by all agencies. We have also been open about the number of agencies in the country that have never opened the reports. HPS is happy to report that, for the 8 months ending December 20, 2017, 58.5% of all hospices have opened their reports. Only 5 states and 1 territory are below 50%. The sad news is that home care…

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Hospice Aggregate Cap Update

By Katie Wehri / Posted on: January 5, 2018

Hospices are reminded that the Aggregate Cap calculation is due to their Medicare Administrative Contractor (MAC) no later than February 28, 2018. This is one month earlier than in the past due to the fact that the cap accounting year for both the inpatient cap and the hospice aggregate cap is being aligned with the federal fiscal year. Not only does this change the due date for the Aggregate Cap calculation it also changes the timeframes used for the calculation.

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New Medicare Beneficiary Identifiers

By Melinda A. Gaboury, CEO / Posted on: December 20, 2017

HPS has given you a couple of updates on the new Medicare Beneficiary Identifier (MBI) cards over the past few months and we continue that update today. Following are more questions answered about the new Medicare numbers and how that will affect your agency. Key dates to remember: April 1, 2018 – Patients will begin to receive new Medicare cards and agencies should begin the process of asking…

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Hospice Physicians – Enroll in PECOS or State Medicaid Plans?

By Katie Wehri / Posted on: December 8, 2017

The answer is – it depends. There is no Medicare requirement specific to hospices needing to ensure hospice medical directors/physicians or hospice patients’ attending physicians need to be enrolled in PECOS. This does not mean that hospice physicians should not be enrolled, however. Provisions of the Affordable Care Act require all providers of medical or other items or services and suppliers that qualify for a National Provider Identifier (NPI) to include their NPI on all applications to enroll in the Medicare and Medicaid programs and…

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Opioid Disposal and Destruction – Considerations for Hospices

By Katie Wehri / Posted on: November 17, 2017

With the expanding focus on opioid misuse in this country, hospice has gotten some extra attention regarding its responsibilities in this epidemic. Most all hospices were disposing of unused/unwanted medications of hospice patients who were in their home up until late 2014 when the Disposal of Controlled Substances Act (Disposal Act) was finalized and implemented by the Drug Enforcement Administration (DEA). Prior to this time, there was not…

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2018 Home Health Final Rule

By Melinda A. Gaboury, CEO / Posted on: November 14, 2017

The Breaking News that has every one full of excitement and hope is that the 2018 Home Health Final Rule does NOT include finalizing HHGM, at this time, which was set for implementation in 2019! The battle has been won, BUT the war has just begun! Some form of payment reform will occur in home health. It is not…

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Preparing for Hospice Targeted Probe and Educate (TPE)

By Katie Wehri / Posted on: October 31, 2017

As previously reported, the targeted probe and educate (TPE) process is replacing the medical review process used by Medicare Administrative Contractors (MAC).  Each of the three MACs – Palmetto GBA, NGS and CGS – can choose the topics for review under TPE based on existing data analysis procedures.

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Claim Denials Due to NO OASIS Will Now Return to Provider

By Melinda A. Gaboury, CEO / Posted on: October 23, 2017

The claim edit that has been in place since April 3, 2017 has been denying home health claims, at the point of billing, if the matching OASIS was not in the ASAP database. Some of these denials have been the result of data not matching between the claim and the OASIS, primarily the patient’s HIC number being different or the OASIS…

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Hospice CTI and Election Statement Made Easy

By Katie Wehri / Posted on: October 16, 2017

CMS reminded hospices recently about the need to comply with Medicare hospice election statements and certification of terminal illness (CTI) requirements. This reminder comes shortly after CMS’ announcement of the expansion of the targeted probe and educate (TPE) method of medical review to hospices and other provider types. We believe there is a strong possibility that CMS will…

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New Medicare Cards – Questions Answered

By Melinda A. Gaboury, CEO / Posted on: October 10, 2017

HPS reported on the coming changes to the Medicare cards a few months ago. Today we offer more answers as have been gathered from CMS via the Medicare Learning Network page of the CMS site. The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, requires the removal…

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Corrections to SIA & RHC Made Easy

By Katie Wehri / Posted on: September 29, 2017

CMS announced this week that Medicare Administrative Contractors (MAC) will accept a list of claims to be adjusted for incorrect service intensity add-on (SIA) and incorrect routine home care (RHC) payments, where the error is not related to hospice beneficiary transfers. The SIA and high/low RHC payment changes were…

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Targeted Probe and Educate

By Melinda A. Gaboury, CEO / Posted on: September 25, 2017

HPS reported recently regarding continued Probe & Educate for Home Health agencies. This is to clarify that the CMS expansion on Probe & Educate is for Home Health and Hospice and will be effective 10/1/2017. This is referred to as Targeted Probe & Educate (TPE). This review will include targeted medical review and education along with an option for potential elevated action, up to and including referral to other Medicare contractors including the Zone Program Integrity Contractor (ZPIC), Unified Program Integrity Contractor (UPIC), Recovery Audit Contractor (RAC), etc.

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GIP Level of care

Hospice General Inpatient Care

By Leslie Heagy, RN, COS-C / Posted on: September 18, 2017

CMS continues to be concerned about hospice over utilization and hospice underutilization of the general inpatient (GIP) level of care. Are hospices providing access to all four levels of hospice care (routine home care, general inpatient care, respite care and continuous home care)?

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2018 OASIS-C2 Guidance Manual Update

By Melinda A. Gaboury, CEO / Posted on: September 8, 2017

CMS issued a statement and an update to the OASIS-C2 Guidance Manual regarding the One Clinician Convention. CMS states: “As required by the Conditions of Participation, the Comprehensive Assessment will continue to be the responsibility of one clinician. However, effective January 1, 2018, the assessing clinician will be allowed to elicit feedback from other agency staff, in order to complete any or all OASIS items integrated within the Comprehensive Assessment.” One key element that agencies should…

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Updates to the Hospice Aggregate Cap

By Katie Wehri / Posted on: September 1, 2017

The inpatient cap limits the number of days of inpatient care for which a hospice can bill Medicare to no more than 20% of total Medicare days billed, and the aggregate cap limits the total dollar amount of payments from Medicare that can be received. The aggregate cap was originally intended to ensure that hospice payments would not exceed Medicare expenditures in a conventional setting. The aggregate cap amount is…

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Hospice Compare Site Now Live

By Katie Wehri / Posted on: August 18, 2017

On August 16, 2017 the long-awaited Hospice Compare site went live. The Compare site is part of the Hospice Quality Reporting Program (HQRP) mandated by the Affordable Care Act (ACA). CMS uses Compare sites as part of the quality programs for various provider types. All are similar in that they offer a snapshot of the quality of care provided to patients that is available to the public.

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2018 Home Health Proposed Rule – HH QRP

By Melinda A. Gaboury, CEO / Posted on: August 14, 2017

The 2018 Home Health Proposed Rule was released 07/28/17. The 2018 Home Health Proposed Payment Rule – Including Intro to HHGM regarding this rule primarily discussed the proposed reimbursement changes for 2018 as well as the massive changes to the Prospective Payment System in the form of HHGM. The following is a recap of the proposed changes to the Home Health Quality Reporting Program (HH QRP).

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2018 Hospice Final Rule & NOE Electronic Submission

By Katie Wehri / Posted on: August 4, 2017

Late Tuesday, August 1, 2017 the final hospice rule – FY 2018 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements – was posted. The rule contains the FY2018 finalized payment rates, aggregate cap, and hospice quality reporting changes. On July 27, 2017 CMS released Transmittal 3813/Change Request (CR) 10064 – Accepting Hospice Notices of Election via Electronic Data Interchange. Hospices will be happy to hear…

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2018 Home Health Proposed Payment Rule – Including Intro to HHGM

By Melinda A. Gaboury, CEO / Posted on: July 31, 2017

The Centers for Medicare and Medicaid Service (CMS) released the CY2018 Medicare Home Health payment rule last week. This proposed rule is voluminous and carries an immense number of proposed changes.  HPS will continue analyzing and updating on the proposed elements of this rule.

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Hospice Quality Reporting Update

By Katie Wehri / Posted on: July 24, 2017

There have been several updates to the Hospice Quality Reporting Program (HQRP) recently, most notably that CMS has provided notifications to hospices that were determined to be non-compliant with HQRP requirements for calendar year (CY) 2016, which will affect their fiscal year (FY) 2018 Annual Payment Update (APU). The non-compliance notification letters are dated July 18, 2017 and were sent via the US postal service and are also available in CASPER.  The CASPER letter also identifies…

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Delayed Implementation of Home Health CoPs

By Melinda A. Gaboury, CEO / Posted on: July 14, 2017

Last week CMS issued a Final Rule that changed the new Home Health CoPs rule implementation date to January 13, 2018. HPS announced the proposed rule a few months ago. NAHC and the Forum of State Associations spearheaded this effort to postpone the rule because of the extensive changes that are…

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Home Care & Hospice Emergency Preparedness

By Katie Wehri / Posted on: July 7, 2017

We will continue to update this article to keep you informed on the latest concerning Home Care & Hospice Emergency Preparedness. UPDATE – July 7, 2017 – Since the release of this article, the interpretive guidelines for emergency preparedness have been released. HPS has created a detailed table for Home Health and Hospice providers to assist our Alliance members in managing the EP information…

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Changes Coming to Medicare HIC Numbers – Medicare Beneficiary Identifier

By Aaron Carey / Posted on: June 22, 2017

Former President Harry S. Truman was the very first Medicare beneficiary to be issued a Health Insurance Claim Number (HICN) when then President Lyndon B Johnson signed the Medicare program into law on July 30, 1965. Ever since then, Medicare beneficiaries upon entitlement, have been issued a Health Insurance Claim Number (HICN). The primary issuer of the HICN is the social security administration with the railroad retirement Board issuing HIC numbers for railroad workers. Beginning in 2018 the Medicare HIC number will be replaced with a new identifier called a Medicare Beneficiary Identifier (MBI). The MBI numbers will be…

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Hospice Quality Reporting Program Update – HIS and Hospice Compare

By Katie Wehri / Posted on: June 16, 2017

CMS recently released clarification of the response options for HIS item A1400, Payor Information.  Many hospices have been asking how to complete this item with questions about the Self Pay option, in particular.  In addition to the information in the HIS Manual, CMS provides the following additional information specific to the…

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Attending versus Referring Physician in Hospice

By Leslie Heagy, RN, COS-C / Posted on: June 1, 2017

A physician refers a patient to hospice care – what role does this physician play in the care of the patient and in certifying the patient? It depends. Let’s look at the various hospice requirements that involve a physician.

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Home Health PEPPER is HOT!

By Melinda A. Gaboury, CEO / Posted on: May 26, 2017

One of the Hot Topics surrounding the medical review contractors and Medicare MACs is Home Health PEPPER (Program for Evaluating Payment Patterns Electronic Report)! Pepper is an accumulation and calculation of certain statistics that result from claims data. These Medicare claims data statistics are calculated for areas that may be at risk for improper Medicare payments such as…

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HHCAHPS – Improvement in Specific Care Issues

By Melinda A. Gaboury, CEO / Posted on: May 12, 2017

Are you monitoring the agency’s HHCAHPS Star Ratings? There are numerous questions on the survey that the patients must complete, but only selected ones go into the outcome calculation and eventual star rating. The Composite Measure – Specific Care Issues, seems to be one that most agencies struggle with. The specific questions from the survey…

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Hospice Proposed Rule

By Leslie Heagy, RN, COS-C / Posted on: April 27, 2017

In addition to the proposed changes for hospice providers CMS included proposed changes to the Home Health Quality Reporting program (HH QRP) to resume in the reporting for January 2022. The proposed rule for hospice and home health QRP is summarized in today’s blog.

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Negative Pressure Wound Therapy with a Disposable Device Billing Specifics (NPWT)

By Melinda A. Gaboury, CEO / Posted on: April 21, 2017

The 2017 Final Home Care Rule included clarification that payment for the NPWT device is when a HHA “furnishes NPWT using a disposable device” to mean when the HHA provider is either initially applying an entirely new disposable NPWT device, or removing a disposable NPWT device and replacing it with an entirely new one.

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Home Health COPs Delayed

By Melinda A. Gaboury, CEO / Posted on: March 31, 2017

CMS just issued a proposed rule that will change the new Home Health CoP rule effective date to January 13, 2018. NAHC and the Forum of State Associations spearheaded an effort to postpone the rule because of the extensive changes that are required and the absence of needed interpretive guidance to properly comply.

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How To Access The Provider Statistical & Reimbursement Report

By Aaron Carey / Posted on: March 17, 2017

It is that time of year again. Cost report season for home health and hospice providers. Cost reports are due five months after your agency fiscal year end. For agencies with a 12/31/16 fiscal year end cost reports are due by 05/31/17.

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HIPAA for Home Care | Establishing A Compliant Agency

By Drew Rowley / Posted on: March 3, 2017

HIPAA has become an acronym synonymous with healthcare. We see it practiced and preached daily throughout the home care and hospice industry. However, too often breach notifications are at the top of our industry headlines. These breaches are costing our agencies time, money, and patient credibility. If we as agency owners, administrators, and employees understand the severity of a breach then why are breaches still occurring?

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Are You Thriving?

By Melinda A. Gaboury, CEO / Posted on: January 20, 2017

The constant additions of new programs and new methods, updates and consideration of changes is almost unbearable for some agencies.  Home Health has been hit really hard since 2008 and no relief seems to be coming.   Value-Based Purchasing, Pre-Claim Review, New CoPs, OASIS-C2, ICD-10 CM and now possibly major changes to the Prospective Payment System in regard to reimbursement.

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Are you G Code Savvy?

By Melinda A. Gaboury, CEO / Posted on: January 13, 2017

Many have not yet realized that there were additional G codes introduced that went into effect January 1, 2017. These codes were not a part of the 2017 Home Health Final Rule, but were introduced in the CR9736 issued November 10, 2016.

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Late NOE Exceptions Clarified

By Melinda A. Gaboury, CEO / Posted on: January 4, 2017

Notices of Election (NOE) that are filed and/or accepted at the Medicare Administrative Contractor (MAC) outside of the required 5 calendar day requirement, penalizes the hospice and the hospice does not receive reimbursement for any services until the NOE is accepted at the MAC.  There have been some significant reimbursement issues with hospices due to this requirement, even when the issue was out of the control of the hospice and due to a Medicare system processing issue.

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Search Home Health in the NEAR Future!

By Melinda A. Gaboury, CEO / Posted on: December 21, 2016

The vice just gets tighter and tighter and the heat gets hotter!  Agencies are struggling to keep their heads above water and to keep up with the massive amounts of…

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NO OASIS Submission Equals NO Payment

By Aaron Carey / Posted on: November 15, 2016

The day has come that many agencies are going to be surprised by and that many have feared.  A long standing federal regulation requires the transmission and acceptance of the…

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2017 FINAL Home Health Rule

By Melinda A. Gaboury, CEO / Posted on: November 3, 2016

CMS released the 2017 Final Home Health Payment Rule on October 31, 2016. RATE CHANGES 2017 brings the 4th and final year of this round of rebasing.  Different from the…

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Reimbursement Impact of OASIS-C2

By Melinda A. Gaboury, CEO / Posted on: October 7, 2016

Effective January 1, 2107, home health is facing full implementation of OASIS-C2. One of the biggest changes, with OASIS-C2, is the treatment of Stage 3 and 4 pressure ulcers when the wound…

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The FOUR Questions!

By Melinda A. Gaboury, CEO / Posted on: September 27, 2016

Have you heard the latest?  Are you in the “know” regarding medical review documentation requirements of your Medicare Home Health Charts? Many of you know that the Pre-Claim Review Demonstration began…

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BREAKING NEWS – PRE-CLAIM REVIEW DELAYED

By Melinda A. Gaboury, CEO / Posted on: September 20, 2016

After much work and dedication from the Home Care Association of Florida (HCAF), the National Association for Home Care & Hospice (NAHC), wonderful Senators from Florida, other State Home Care…

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Pressure Ulcer Unlearning!

By Melinda A. Gaboury, CEO / Posted on: September 14, 2016

Unlearning: to put out of one’s knowledge or memory or to undo the effect of or discard the habit of.  This is what we have to do with most everything…

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OASIS-C2: Are you Prepared?

By Melinda A. Gaboury, CEO / Posted on: September 7, 2016

Hopefully your preparation for OASIS-C2 implementation has begun and due to that your Thanksgiving, Christmas and New Year’s Celebration will NOT be stressful. January 1, 2017 will bring with it…

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Hospice Regulatory Update

By Melinda A. Gaboury, CEO / Posted on: August 18, 2016

Over the last few weeks there have been updates that hospice should be aware of:  the 2017 Final Rule has been issued and Medicare MACs have finally acknowledged that the…

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2017 Proposed Home Health Rule

By Melinda A. Gaboury, CEO / Posted on: July 13, 2016

CMS released the 2017 Proposed Home Health Payment Rule and while some things are a bit of a surprise, most are not. RATE CHANGES 2017 brings the 4th and final year…

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The Battle Over HbA1c Has Been Won!

By Melinda A. Gaboury, CEO / Posted on: July 1, 2016

For too long home health agencies, with Palmetto GBA as their Medicare MAC, have been fighting physicians over trying to get orders and information needed to meet the Local Coverage…

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HHCAHPS – Is There Room for Improvement?

By Melinda A. Gaboury, CEO / Posted on: April 28, 2016

Home Health Agencies are required to conduct HHCAHPS through a third party vendor and submit that data to CMS, assuming the agencies has treated 60 Medicare patients in a given…

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The Continued Culture Change to Quality

By Melinda A. Gaboury, CEO / Posted on: April 8, 2016

When agencies take a hardcore look at what the culture of the agency is today, they will typically find that concern at monthly meetings revolves around drops in number of…

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Culture of Quality

By Melinda A. Gaboury, CEO / Posted on: March 21, 2016

How hard is it to develop a culture? One definition of culture: A culture is a way of life of a group of people–the behaviors, beliefs, values, and symbols that…

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Can You Afford to Ignore?

By Melinda A. Gaboury, CEO / Posted on: March 11, 2016

Home Health Agencies across the country face continuing payment cuts in all aspects of their payer mix.  Medicare, Medicare Advantage, Medicaid and commercial payers continue to cut rates and in…

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Will it Ever End? – Medicare Prior Authorization!

By Melinda A. Gaboury, CEO / Posted on: February 26, 2016

The initiatives to stop Medicare Fraud and Abuse are becoming more numerous and cumbersome. How much more are agencies going to be able to endure?  The most recent is the announcement…

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Key Points Regarding 2016 Hospice Payment Reform

By Melinda A. Gaboury, CEO / Posted on: February 19, 2016

The two most significant changes associated with 2016 Hospice Payment Reform are the High vs. Low rates for Routine Home Care (RHC) level of care days and the Service Intensity Add-On…

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Medicaid and F2F: The Day has Officially Arrived!

By Leslie Heagy, RN, COS-C / Posted on: February 9, 2016

CMS recently issued a final rule that will require a Face-to-Face (F2F) encounter for Medicaid patients receiving home health services or Durable Medical Equipment (DME) and may expand coverage of…

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Hospice CAHPS Surveys Will Affect Payment

By Melinda A. Gaboury, CEO / Posted on: January 29, 2016

The regulatory issues just keep mounting with both home health and hospice. This information is technically not new, but needs to be reiterated for hospices that may not be as…

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Value Based Purchasing: What We Weren’t Sure of!

By Melinda A. Gaboury, CEO / Posted on: January 14, 2016

Value Based Purchasing is alive and well and dwelling within Nine States! Agencies have been hard at work preparing for this and continue to strive toward being the best that…

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2016 HHRG Tables & Hospice CBSAs!

By Melinda A. Gaboury, CEO / Posted on: December 22, 2015

2016 Prospective Payment System (PPS) Rates are just around the corner for home health! These rates will be in effect for episodes ENDING 01/01/16. When the final claim is proposed…

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2016 HHRG Tables & Hospice CBSAs!

By Melinda A. Gaboury, CEO / Posted on: December 22, 2015

2016 Prospective Payment System (PPS) Rates are just around the corner for home health! These rates will be in effect for episodes ENDING 01/01/16. When the final claim is proposed…

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Ushering In 2016 – Kick off the Year Right!

By Melinda A. Gaboury, CEO / Posted on: December 11, 2015

With the ushering in of 2016 there comes a great many changes that will affect both home health and hospice. 1. New G-Codes to distinguish between RN (G0299) and LPN/LVN…

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2016 Home Health Rates Continued Decline!

By Melinda A. Gaboury, CEO / Posted on: November 13, 2015

CMS issued the Home Health Final Rule for 2016 and while the Value Based Purchasing (VBP) is a huge deal, agencies do not need to overlook the reimbursement impact of…

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The Nervous Nine Have Been Confirmed!

By Melinda A. Gaboury, CEO / Posted on: November 2, 2015

Are you one of The Confirmed Nervous Nine? The Nervous Nine are the Nine States that have been selected for the Value-Based Purchasing (VBP) Pilot Program under the Medicare Home…

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New G-Codes Not JUST for HOSPICE!

By Melinda A. Gaboury, CEO / Posted on: October 23, 2015

Change Request (CR) 9369 was released by CMS on Friday, October 16, 2015, providing Additional G-Codes that will differentiate Registered Nurses (RNs) and Licensed Practical Nurses (LPNs) in Home Health…

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The Complexities of Medicare Secondary Payer Billing

By Aaron Carey / Posted on: October 16, 2015

Medicare has always looked to liability insurance policies, no-fault insurance policies, and workers’ compensation plans to pay for services related to injuries associated with those policy types. Recent changes to…

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Initials and Not a Full Signature, Allowed?

By Melinda A. Gaboury, CEO / Posted on: October 9, 2015

One of the things home health and hospices frequently have issues with is physician signatures. Often the issues surround the physician not dating their signature or making changes on hard…

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The Y2K of Coding!

By Melinda A. Gaboury, CEO / Posted on: October 5, 2015

Most of you will recall the scare that ran rampant throughout the country with Y2K, well basically the same thing happened with ICD-10 Coding. We were able to get a…

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Finally Some Relief or Not!

By Melinda A. Gaboury, CEO / Posted on: September 29, 2015

There is not much that is more frustrating than receiving a denial after submitting a chart to a reviewer, resolving the issue and then under appeal it is denied again…

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Home Care and Hospice: Still No Relief!

By Melinda A. Gaboury, CEO / Posted on: September 11, 2015

It was announced last week that Home Care and Hospice would receive NO relief from ICD-10 codes being required on Home Care and Hospice claims. Earlier this year, CMS issued…

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Is Canceling RAPs a Strategy for your Agency?

By Melinda A. Gaboury, CEO / Posted on: August 31, 2015

Typically the Home Health and Hospice Medicare MACs follow each other when one begins a new review, develops a new LCD, etc. Palmetto GBA (PGBA) is the largest Medicare MAC…

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CMS Issues 2016 FINAL Hospice Rule – Part 2

By Melinda A. Gaboury, CEO / Posted on: August 21, 2015

The FINAL Hospice Payment Rule was released on July 31, 2015 and addresses payment reform. Additionally, the 2016 Final Hospice Rule addresses the Aggregate Cap changes. The 2016 cap year,…

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CMS Issues 2016 FINAL Hospice Payment and Quality Rule

By Melinda A. Gaboury, CEO / Posted on: August 7, 2015

The FINAL Hospice Payment Rule was released on July 31, 2015 and addresses payment reform of the routine home care (RHC) level of care by providing a payment of two…

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Cert and Recert Clarification for Home Health

By Melinda A. Gaboury, CEO / Posted on: July 31, 2015

Change Request (CR) 9189 was released July 10, 2015 was an implementation date of August 11, 2015. This CR was issued to update the Medicare Program Integrity Manual, Chapter 6…

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Are You Overwhelmed by it All?

By Melinda A. Gaboury, CEO / Posted on: July 22, 2015

It seems that everything is happening at once and agencies are beginning to feel the pressure, more than ever, to keep up with it all and make sure they reach…

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2016 Proposed Rates Cannot Be Ignored!

By Melinda A. Gaboury, CEO / Posted on: July 15, 2015

As I am sure everyone has heard by now, CMS issued the Home Health Proposed Regulation for 2016 rates and Value Based Purchasing (VBP) Pilot on July 6, 2015! There…

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The Nervous Nine!

By Melinda A. Gaboury, CEO / Posted on: July 9, 2015

Are you one of The Nervous Nine? The Nervous Nine are the Nine States that have been selected for the Value-Based Purchasing (VBP) Pilot Program under the Medicare Home Care…

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Medicare Web Portals – Navigating the “Dark Days”

By Aaron Carey / Posted on: June 28, 2015

Home Care and hospice providers usually rely on the Medicare DDE system or their software systems for Medicare eligibility verifications. Some agencies leverage their relationship with various network service vendors…

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Hospice Medicaid Room and Board Billing Tips

By Aaron Carey / Posted on: June 7, 2015

State Medicaid programs will reimburse hospice agencies 95% of the room and board costs they incur for treating eligible Medicaid patients in nursing facilities. It would be simple if the…

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Home Care HIPPS Code Corrections When Re-Coded

By Melinda A. Gaboury, CEO / Posted on: May 27, 2015

For Home Care agency collectors there has been a seemingly never-ending saga of research, in many cases, to ensure that the agency was paid appropriately by Medicare. At the core…

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Hospice Update on Attending Physician

By Melinda A. Gaboury, CEO / Posted on: May 20, 2015

Centers for Medicare & Medicaid Services (CMS) has rescinded Change Request 9114 and has posted a replacement CR 9114 and a related Medlearn Matters article. This is in response to…

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CMS Issues FY2016 Proposed Hospice Payment and Quality Rule

By Melinda A. Gaboury, CEO / Posted on: May 6, 2015

The PROPOSED Hospice Payment Rule was released on April 30, 2015 and addresses payment reform of the routine home care (RHC) level of care by providing a payment of two…

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Are You Sending Everything Needed for Therapy ADR Review?

By Leslie Heagy, RN, COS-C / Posted on: April 28, 2015

Effective April 1, 2015, Palmetto GBA is requiring additional therapy documentation for all Additional Documentation Request (ADRs) that contain continued therapy services into the subsequent episode. In addition to the…

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Medicare Managed Care – Can it be Managed? (Part Three)

By Aaron Carey / Posted on: April 21, 2015

This, the final article in a series of three, will focus on the all-important billing and collections aspect of your relationship with managed care payers. Proper credentialing and meticulous attention…

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Medicare Managed Care – Can it be Managed? (Part Two)

By Aaron Carey / Posted on: April 15, 2015

Our last article focused on the complexities of the credentialing process with managed care payers. Part two of this three part series will focus on what happens after credentialing, specifically…

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Medicare Managed Care – Can it be Managed?

By Aaron Carey / Posted on: April 6, 2015

As Medicare reimbursement cuts continue agencies will be forced to expand into the managed care and private insurance markets. Doing so is a complicated process that involves contracting, intake process…

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Are You Convinced Your Agency is ICD-10 Ready?

By Melinda A. Gaboury, CEO / Posted on: April 1, 2015

The Medicare Administrative Contractors (MACs) will be conducting both Acknowledgement Testing and End-to-End Testing for ICD-10 readiness. Agencies will not even need to register for Acknowledgement Testing. However, agencies MUST…

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Home Care Diabetic Patients Under The Microscope

By Leslie Heagy, RN, COS-C / Posted on: March 24, 2015

Palmetto GBA’s Local Coverage Determination (LCD- L35413) regarding monitoring glucose control in patients with Type II Diabetes Mellitus was effective 12/30/14. The LCD contains specific requirements for Type II diabetic…

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Are Agencies Up to Date on Revalidation Requirements?

By Melinda A. Gaboury, CEO / Posted on: March 17, 2015

All agencies must participate in the revalidation process. This requirement has been updated by the Change Request (CR) 9011 that was recently issued with an effective date of 05/15/15. This…

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Additional Development Request Checklist

By Leslie Heagy, RN, COS-C / Posted on: March 9, 2015

Agencies continue to report receiving Additional Development Requests from their respective Medicare Administrative Contractors (MAC). Unless your agency is one of the lucky few, you have experienced the anxiety first…

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Hospice Untimely NOE and CAP Self Reporting

By Melinda A. Gaboury, CEO / Posted on: March 3, 2015

HOSPICE UNTIMELY NOE With the new timely filing deadline for the filing and acceptance of the Notice of Election (NOE) documents there are reimbursement issues that occur when those timely…

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Home Care Medical Necessity Documentation

By Melinda A. Gaboury, CEO / Posted on: February 18, 2015

Medical review of home care charts, from many different organizations, has haunted home care agencies over the past couple of years. Lack of adequate Face to Face documentation has led…

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OASIS to Claim Data Matching

By Aaron Carey / Posted on: February 9, 2015

Medicare determines payments of home care claims using case-mix groups derived from the OASIS assessments of the beneficiary. Home care agencies submit the case-mix groups on their claims as a…

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Hospice CAP Self-Reporting: Are you prepared?

By Melinda A. Gaboury, CEO / Posted on: February 3, 2015

2015 brought a major new requirement to the front door step of Hospice agencies! All hospices, regardless of whether for profit or not, must self report aggregate cap calculations to…

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2015 Therapy Compliance Changes

By Aaron Carey / Posted on: January 19, 2015

Since 2011, home care agencies have suffered under the administrative burden of stringent therapy reassessment requirements that required a therapy reassessment visit for each discipline of therapy at least once…

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Home Care Final Rule 2015: Case-Mix & CBSA Changes!

By Melinda A. Gaboury, CEO / Posted on: January 12, 2015

The 2015 Home Care Final Rule has brought about MANY changes in the home care calculations for payment in addition to the Face to Face (F2F) changes that were discussed…

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Home Care Final Rule 2015: Case-Mix & CBSA Changes!

By Melinda A. Gaboury, CEO / Posted on: January 12, 2015

The 2015 Home Care Final Rule has brought about MANY changes in the home care calculations for payment in addition to the Face to Face (F2F) changes that were discussed…

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Face to Face 2015 – What we know so far!

By Melinda A. Gaboury, CEO / Posted on: January 5, 2015

Happy New Year & Welcome to The HPS Blog There have been many concerns and questions surrounding the 2015 Home Care Face to Face (F2F) documentation requirements since the release…

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