Category: Home Health Documentation & OASIS
PDGM Series: The 2020 Proposed Rule Update
By Melinda A. Gaboury, CEO / Posted on: August 27, 2019January 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, 2019CMS 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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Review Choice Demonstration Implementation Plan
By Melinda A. Gaboury, CEO / Posted on: April 3, 2019The 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, 2019Home 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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The Review Choice Demonstration (RCD) Is Here!
By Melinda A. Gaboury, CEO / Posted on: March 13, 2019The 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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OASIS-D: ARE YOU READY FOR 2019?
By Melinda A. Gaboury, CEO / Posted on: October 30, 2018OASIS 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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2019 Home Health Proposed Payment Rule – PDGM 2020
By Melinda A. Gaboury, CEO / Posted on: August 8, 2018The 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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Diagnosis Coding for Home Care – Tips for Success
By Melinda A. Gaboury, CEO / Posted on: July 2, 2018ICD-10-CM implementation brought about many changes related to our coding world. However, several things remained the same and it is important to remember the constant factors that have not changed. 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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Pre-Claim Review Demonstration Coming Back?
By Melinda A. Gaboury, CEO / Posted on: June 7, 2018CMS 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, 2018OASIS 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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Targeted Probe and Educate – What We Have Learned So Far
By Melinda A. Gaboury, CEO / Posted on: March 13, 2018Targeted 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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2018 Home Health Final Rule
By Melinda A. Gaboury, CEO / Posted on: November 14, 2017The 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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Claim Denials Due to NO OASIS Will Now Return to Provider
By Melinda A. Gaboury, CEO / Posted on: October 23, 2017The 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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Targeted Probe and Educate
By Melinda A. Gaboury, CEO / Posted on: September 25, 2017HPS 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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2018 OASIS-C2 Guidance Manual Update
By Melinda A. Gaboury, CEO / Posted on: September 8, 2017CMS 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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2018 Home Health Proposed Rule – HH QRP
By Melinda A. Gaboury, CEO / Posted on: August 14, 2017The 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 Home Health Proposed Payment Rule – Including Intro to HHGM
By Melinda A. Gaboury, CEO / Posted on: July 31, 2017The 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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Delayed Implementation of Home Health CoPs
By Melinda A. Gaboury, CEO / Posted on: July 14, 2017Last 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 Health COPs Delayed
By Melinda A. Gaboury, CEO / Posted on: March 31, 2017CMS 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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HIPAA for Home Care | Establishing A Compliant Agency
By Drew Rowley / Posted on: March 3, 2017HIPAA 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, 2017The 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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Late NOE Exceptions Clarified
By Melinda A. Gaboury, CEO / Posted on: January 4, 2017Notices 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.
VIEW POSTSearch Home Health in the NEAR Future!
By Melinda A. Gaboury, CEO / Posted on: December 21, 2016…
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Reimbursement Impact of OASIS-C2
By Melinda A. Gaboury, CEO / Posted on: October 7, 2016…
VIEW POSTBREAKING NEWS – PRE-CLAIM REVIEW DELAYED
By Melinda A. Gaboury, CEO / Posted on: September 20, 2016…
VIEW POSTThe Battle Over HbA1c Has Been Won!
By Melinda A. Gaboury, CEO / Posted on: July 1, 2016…
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Medicaid and F2F: The Day has Officially Arrived!
By Dedra Briggs / Posted on: February 9, 2016…
VIEW POSTNew G-Codes Not JUST for HOSPICE!
By Melinda A. Gaboury, CEO / Posted on: October 23, 2015…
VIEW POSTInitials and Not a Full Signature, Allowed?
By Melinda A. Gaboury, CEO / Posted on: October 9, 2015…
VIEW POSTHome Care and Hospice: Still No Relief!
By Melinda A. Gaboury, CEO / Posted on: September 11, 2015…
VIEW POSTCert and Recert Clarification for Home Health
By Melinda A. Gaboury, CEO / Posted on: July 31, 2015…
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Are You Sending Everything Needed for Therapy ADR Review?
By Dedra Briggs / Posted on: April 28, 2015…
VIEW POSTAre You Convinced Your Agency is ICD-10 Ready?
By Melinda A. Gaboury, CEO / Posted on: April 1, 2015…
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Home Care Diabetic Patients Under The Microscope
By Dedra Briggs / Posted on: March 24, 2015…
VIEW POSTHome Care Medical Necessity Documentation
By Melinda A. Gaboury, CEO / Posted on: February 18, 2015…
VIEW POSTFace to Face 2015 – What we know so far!
By Melinda A. Gaboury, CEO / Posted on: January 5, 2015…
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