Category: Home Health Regulation & Compliance
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.
VIEW POSTOASIS-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.
VIEW POSTAre You Prepared? The Patient Driven Groupings Model (PDGM) Is Coming Soon
By Melinda A. Gaboury, CEO / Posted on: April 30, 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.
VIEW POSTReview 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!
VIEW POST7 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.
VIEW POSTThe 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…
VIEW POSTAgencies at Risk for Missing FIPS Codes
By Melinda A. Gaboury, CEO / Posted on: January 30, 2019Home Health Agencies across the country are at risk for penalties and recouped claims if the FIPS code is NOT reported on ALL CLAIMS!
VIEW POST2019 Rural Add-On Changes
By Melinda A. Gaboury, CEO / Posted on: November 30, 2018As 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.
VIEW POSTOASIS-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.
VIEW POST2019 Value Based Purchasing Proposed Changes (UPDATED)
By Melinda A. Gaboury, CEO / Posted on: August 27, 2018The 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.
VIEW POST2019 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.
VIEW POSTDiagnosis 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.
VIEW POSTPre-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.
VIEW POSTOASIS 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.
VIEW POST
Home Health MedPAC Report to Congress
By Katie Wehri / Posted on: April 13, 2018Each 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.
VIEW POSTTargeted 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.
VIEW POSTCAHPS – Home Health & Hospice
By Melinda A. Gaboury, CEO / Posted on: March 2, 2018Are 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…
VIEW POSTHHCCN, ABN, NOMNC – Which Form Do I Use?
By Melinda A. Gaboury, CEO / Posted on: February 9, 2018Home 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.
VIEW POSTHome Health & Hospice PEPPER Reports
By Melinda A. Gaboury, CEO / Posted on: January 15, 2018Over 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…
VIEW POSTNew Medicare Beneficiary Identifiers
By Melinda A. Gaboury, CEO / Posted on: December 20, 2017HPS 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…
VIEW POST2018 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…
VIEW POSTClaim 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…
VIEW POSTNew Medicare Cards – Questions Answered
By Melinda A. Gaboury, CEO / Posted on: October 10, 2017HPS 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…
VIEW POSTTargeted 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.
VIEW POST2018 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…
VIEW POST2018 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).
VIEW POST2018 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.
VIEW POSTDelayed 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…
VIEW POSTHome Care & Hospice Emergency Preparedness
By Katie Wehri / Posted on: July 7, 2017We 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…
VIEW POST
Changes Coming to Medicare HIC Numbers – Medicare Beneficiary Identifier
By Aaron Carey / Posted on: June 22, 2017Former 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…
VIEW POSTHome Health PEPPER is HOT!
By Melinda A. Gaboury, CEO / Posted on: May 26, 2017One 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…
VIEW POSTHHCAHPS – Improvement in Specific Care Issues
By Melinda A. Gaboury, CEO / Posted on: May 12, 2017Are 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…
VIEW POSTNegative Pressure Wound Therapy with a Disposable Device Billing Specifics (NPWT)
By Melinda A. Gaboury, CEO / Posted on: April 21, 2017The 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.
VIEW POSTHome 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.
VIEW POST
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?
VIEW POSTAre 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.
VIEW POSTAre you G Code Savvy?
By Melinda A. Gaboury, CEO / Posted on: January 13, 2017Many 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.
VIEW POSTLate 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…
VIEW POSTReimbursement 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…
VIEW POSTThe Continued Culture Change to Quality
By Melinda A. Gaboury, CEO / Posted on: April 8, 2016…
VIEW POSTWill it Ever End? – Medicare Prior Authorization!
By Melinda A. Gaboury, CEO / Posted on: February 26, 2016…
VIEW POST
Medicaid and F2F: The Day has Officially Arrived!
By Dedra Briggs / Posted on: February 9, 2016…
VIEW POSTValue Based Purchasing: What We Weren’t Sure of!
By Melinda A. Gaboury, CEO / Posted on: January 14, 2016…
VIEW POST2016 HHRG Tables & Hospice CBSAs!
By Melinda A. Gaboury, CEO / Posted on: December 22, 2015…
VIEW POST2016 HHRG Tables & Hospice CBSAs!
By Melinda A. Gaboury, CEO / Posted on: December 22, 2015…
VIEW POSTUshering In 2016 – Kick off the Year Right!
By Melinda A. Gaboury, CEO / Posted on: December 11, 2015…
VIEW POST2016 Home Health Rates Continued Decline!
By Melinda A. Gaboury, CEO / Posted on: November 13, 2015…
VIEW POSTThe Nervous Nine Have Been Confirmed!
By Melinda A. Gaboury, CEO / Posted on: November 2, 2015…
VIEW POSTInitials and Not a Full Signature, Allowed?
By Melinda A. Gaboury, CEO / Posted on: October 9, 2015…
VIEW POSTIs Canceling RAPs a Strategy for your Agency?
By Melinda A. Gaboury, CEO / Posted on: August 31, 2015…
VIEW POSTCMS Issues 2016 FINAL Hospice Rule – Part 2
By Melinda A. Gaboury, CEO / Posted on: August 21, 2015…
VIEW POSTCert and Recert Clarification for Home Health
By Melinda A. Gaboury, CEO / Posted on: July 31, 2015…
VIEW POST2016 Proposed Rates Cannot Be Ignored!
By Melinda A. Gaboury, CEO / Posted on: July 15, 2015…
VIEW POSTHome Care Diabetic Patients Under The Microscope
By Dedra Briggs / Posted on: March 24, 2015…
VIEW POSTAre Agencies Up to Date on Revalidation Requirements?
By Melinda A. Gaboury, CEO / Posted on: March 17, 2015…
VIEW POST