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.
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.
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.
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.
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.
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.
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?
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.
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.
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.
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.
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.
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…
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.
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: 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…
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…
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.
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…
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…
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…
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.
CMS is concerned about hospice over utilization and hospice underutilization of the general inpatient (GIP) level of care. CMS wonders if hospices are providing access to all four levels of hospice care (routine home care, general inpatient care, respite care and continuous home care) when it sees that some hospices have billed very little or no GIP care during a specified time period. On the other hand, CMS wonders if the…
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…
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…
Late Thursday, April 27 the proposed hospice rule – FY 2018 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements – was posted. The rule contains the proposed FY2018 payment rates, aggregate cap, and hospice quality reporting changes. The proposal is also an opportunity for CMS to provide comments on various other issues and solicit feedback. The proposed rule is open for inspection and CMS is accepting comments from hospices, stakeholders, and the public until June 26. CMS will review the comments and the final rule is anticipated to be released at the end of July. This detailed post will be continually updated with the latest information from CMS regarding the 2018 proposed hospice rule…
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.
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?