Category: Hospice Documentation
Home Health & Hospice Quality Reporting Programs (VIDEO)
By Melinda A. Gaboury, CEO / Posted on: December 6, 2021This 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.
VIEW POSTLocal Coverage Determinations (LCD) (VIDEO)
By Melinda A. Gaboury, CEO / Posted on: October 18, 2021This 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.
VIEW POST
Targeted Probe & Educate: Here We Go Again! (VIDEO)
By Melinda A. Gaboury, CEO / Posted on: August 13, 2021This Minute will take you through a quick recap of the Targeted Probe & Educate framework as the program is being reinstated!
VIEW POST
Emergency Preparedness UPDATE Blog
By Sharon Litwin, RN, MHA, HCS-D / Posted on: May 12, 2021The 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.
VIEW POST
FY2022 Hospice Proposed Payment Rule
By Leslie Heagy, RN, COS-C / Posted on: April 21, 2021In 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.
VIEW POST2022 Hospice Proposed Rule (VIDEO)
By Melinda A. Gaboury, CEO / Posted on: April 12, 2021Welcome 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!
VIEW POST
COVID-19 Coding Changes
By Sharon Litwin, RN, MHA, HCS-D / Posted on: April 8, 2021It 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.
VIEW POSTCOVID-19 Vaccine Administration (VIDEO)
By Melinda A. Gaboury, CEO / Posted on: March 22, 2021Welcome 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!
VIEW POSTOIG Conducting Audit on Telehealth (VIDEO)
By Melinda A. Gaboury, CEO / Posted on: March 15, 2021Welcome 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!
VIEW POSTHospice ADRs on the Rise! (VIDEO)
By Melinda A. Gaboury, CEO / Posted on: March 8, 2021Welcome 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!
VIEW POST
2021 Hospice Final Payment Rule
By Leslie Heagy, RN, COS-C / Posted on: September 2, 2020The 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.
VIEW POST
COVID-19: Interim Final Rule & What It Means for Home Health
By Melinda A. Gaboury, CEO / Posted on: May 14, 2020There 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.
VIEW POSTCOVID-19: Imperative Home Health and Hospice Updates
By Melinda A. Gaboury, CEO / Posted on: April 1, 2020This 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.
VIEW POST
Hospice Targeted Probe and Educate – Avoid Claim Denials
By Leslie Heagy, RN, COS-C / Posted on: February 25, 2020Targeted 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.
VIEW POSTDocumenting Hospice Eligibility for a Cardiopulmonary Diagnosis
By Leslie Heagy, RN, COS-C / Posted on: February 4, 2020When 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.
VIEW POSTTargeted Probe & Educate (TPE): Top 5 Hospice Denial Reasons
By Melinda A. Gaboury, CEO / Posted on: May 30, 2019As 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.
VIEW POST8 Major Changes Outlined in the FY2020 Hospice Wage Index Update
By Leslie Heagy, RN, COS-C / Posted on: May 3, 2019The 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.
VIEW POSTDocumenting Hospice Eligibility for Alzheimer’s Dementia
By Leslie Heagy, RN, COS-C / Posted on: March 22, 2019When 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.
VIEW POSTRequired Hospice GIP Documentation
By Leslie Heagy, RN, COS-C / Posted on: February 4, 2019General 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?
VIEW POSTTop Denial Reasons – Hospice Targeted Probe and Educate
By Leslie Heagy, RN, COS-C / Posted on: September 11, 2018Targeted 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.
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 POST
Preparing for Hospice Targeted Probe and Educate (TPE)
By Katie Wehri / Posted on: October 31, 2017As 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.
VIEW POSTHospice CTI and Election Statement Made Easy
By Katie Wehri / Posted on: October 16, 2017CMS 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…
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 POST
Hospice General Inpatient Care
By Leslie Heagy, RN, COS-C / Posted on: September 18, 2017CMS 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)?
VIEW POSTHospice Quality Reporting Program Update – HIS and Hospice Compare
By Katie Wehri / Posted on: June 16, 2017CMS 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…
VIEW POSTAttending versus Referring Physician in Hospice
By Leslie Heagy, RN, COS-C / Posted on: June 1, 2017A 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.
VIEW POST
Hospice Proposed Rule
By Leslie Heagy, RN, COS-C / Posted on: April 27, 2017In 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.
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 POSTHospice CAHPS Surveys Will Affect Payment
By Melinda A. Gaboury, CEO / Posted on: January 29, 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 POSTHospice Update on Attending Physician
By Melinda A. Gaboury, CEO / Posted on: May 20, 2015…
VIEW POSTAre You Convinced Your Agency is ICD-10 Ready?
By Melinda A. Gaboury, CEO / Posted on: April 1, 2015…
VIEW POST