Utah Home Health Widespread Edit Probe

CGS issues Widespread Home Health Edit Probe for Utah Home Health Agencies.  This was issued based on their recent analysis of billing data for home health agencies in Utah compared to home health agencies in other states served by CGS.  The analysis showed the state of Utah provider’s averaged higher reimbursement per claim, higher average total therapy visits, higher percent of claims with therapy services and higher percent of claims with 20+ therapy visits. 

The topic code for this review will be 5012W, and the probe will select claims with 10 or more therapy visits.  Once selected, the claims will be reviewed for valid FTF encounter documentation, medical necessity, compliance with all CMS coverage guidelines, and correct billing and coding.

For more information please utilize the following link:

http://www.cgsmedicare.com/hhh/pubs/news/2013/0813/cope23084.html

Final Hospice Rates and CAP for 2014

On August 16^th CMS issued transmittal 2766 to update the hospice payment rates, hospice cap, hospice wage index, quality reporting program and the hospice pricer for FY 2014.

Code	Description	2014 Rate	Labor Share	Non-Labor Share
651	Routine Home Care	$156.06	$107.23	$48.83
652	Continuous Home Care 24 Hours Hourly  $37.95	$910.78	$625.80	$284.98
655	Inpatient Respite Care	$161.42	$87.38	$74.04
656	General Inpatient Care	$694.19	$444.35	$249.84

Above rates must be adjusted for wage index.  Hospices that do not submit quality data will have their rates reduced by 2%.

Hospice Cap for FYE 10/31/2013 increases to $26,157.50.

For more information please utilize the following link:

http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/Hospice/Downloads/Transmittal-2766.pdf

Time is Running Out

We are having three excellent seminars at the Hilton Waikoloa Village on the Big Island of Hawaii in September.  The first in the Hospice Leadership Conference on September 18^th to 20^th, the second is the Private Duty Leadership Conference also to be held on September 18^th to 20^th, and the third is the Home Health Leadership Conference to be held on September 23^rd to 25^th. 

The hotel will be releasing rooms on August 15, 2013.

Don’t forget to make your hotel reservations this week.  We still have space available.

For more information please click the appropriate link below:

http://www.hilton.com/en/hi/groups/personalized/K/KOAHWHH-DHW-20130917/index.jhtml?WT.mc_id=POG

Google+

Make your page discoverable on Google.

Additional Data Reporting for Hospice Claims

CMS issued an additional data reporting requirement for hospice claims on July 26, 2013.  It states that Medicare hospices shall report line-item visit data for hospice staff providing general inpatient care (GIP) to hospice patients in skilled nursing facilities (site of services HCPCS code Q5004) or in hospitals (site of service HCPCS Q5005, Q5007, and Q5008).  This includes visits by hospice nurses, hospice aides, social workers, physical therapists, occupational therapist, and speech-language pathologists, on a line-item basis, with call and call length reported as is done for the home levels of care.  CMS is not changing existing GIP visit reporting requirements when the site of services is a hospice inpatient unit (site of services HCPCS code Q5006).  For all visit / call reporting, only report visits / calls by the paid hospice staff: do not report visits by non-hospice staff.

Hospice shall report the National Provider Identifier (NPI) of any nursing facility, hospital, or hospice inpatient facility where the patient is receiving services, regardless of the level of care provided, when the site of service is not the billing hospice.  Hospice shall report injectable and non-injectable prescription drugs on their claims.  Both injectable and non-injectable prescription drugs should be reporting on claims on a line-item basis per fill.  They shall also report infusion pumps on a line-item basis for each pump order and each medical refill.

The Voluntary Reporting for this rule is January 1, 2014 with Mandatory Reporting Effective April 1, 2014.

For more information please utilize the following link:

http://www.cms.gov/Medicare/Medicare-Fee-for-Service Payment/Hospice/Downloads/R2747CP.pdf

CMS Published Final FY 2014 Hospice Wage Index

CMS finalized the FY 2014 Hospice wage index on Friday August 2, 2013.  It is scheduled to be published in the Federal Register on Wednesday August 7^th.   Hospice payments will increase by approximately 1.7 percent over current payment rates, subject to any changes in the state or local wage index rate changes.  The controversial elimination of Adult Failure To Thrive and Debility can no longer be used as primary hospice diagnosis, but CMS will delay returning claims to providers until October 1, 2014.

CMS will change the Hospice Quality Reporting beginning in FY 2016 by implementation of a standardized patient-level data collection instrument call the Hospice Item Set (HIS).  Hospices will be required to complete the HIS at admission and discharge on all patients admitted to hospice starting July 1, 2016.  HIS data submission would affect the payment determination for FY 2016.

The final rule also provides information about CMS’s efforts to develop a Hospice Experience of Care Survey for informal caregivers of hospice patients.  Hospice will be required to begin using the survey in 2015.  The survey will include questions on hospice provider communication with patients and families; hospice provider care; and overall rating of hospice.  CMS will include participation in the survey as a quality-reporting requirement for hospice to receive their full annual payment update beginning in FY 2017.

CMS provided updates on Medicare Hospice payment reform efforts, including a discussion of reform model options; highlights from recent reform research; and update on data collection efforts.

Temporary Link

https://s3.amazonaws.com/public-inspection.federalregister.gov/2013-18838.pdf