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.
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.
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!
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!
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.
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.
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!
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!
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.
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.
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.
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.
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!
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.
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…
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.
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.
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.
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.
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.
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.
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…
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…
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.
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…
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).
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.
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…
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.
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?
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.
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.