CMS Issues Final Home Health PPS Rules and Rate for 2016 - 10-30-2015

CMS has rolled full speed ahead ignoring letters from Senators, members of Congress, and others issuing the Final Home Health PPS Rules and Rates for 2016.  CMS estimates that home health payments will be reduced by 1.4% or $260 million.  The changes include the third year 2.4% reduction for rebasing payments, a .97% reduction for case mix creep, and a 1.4 percent inflation increase.  We will have more emails next week on payment rate specifics.

CMS has also finalized the Home Health Value-Based Purchasing Model.  They have reduced the number of process measures from 10 to 6; have 10 outcome measures; 5 HHCAHPS measures, and reduced the number of reporting measures from 4 to 3.  CMS has made some adjustments to the payment amounts by lowering the first year to a plus or minus 3 percent.  The fifth year will be plus or minus 8 percent. 

If your home health agency is located in Arizona, Florida, Iowa, Maryland, Massachusetts, Nebraska, North Carolina, Tennessee, or Washington you will be required to participate in the model beginning on January 1, 2016.  Actually they have already been collecting data for their base year which will be 2015.

If you are located in one of the 9 states listed above you have 63 days to be ready for HHVPM to begin.  We have two timely One Day Seminars that will give you the information you need to prepare for the changes.  They are titled Winning Strategies – Home Health Value Based Payments.  The first seminar will be held in Louisville, KY on November 10^th.  The second seminar will be held in Orlando, FL on November 17^th.  The seminar topics are:

Understanding the Home Health Value-Based Purchasing Model

How to Succeed Under Home Health Value Based Purchasing

Review of Final Home Health Rules and Rates for 2016

SMART Marketing to Grow and Prosper

 We are pleased to offer $100 per person discount off the current rate because of a sponsorship by TurboQuisine.  The discounted rate including the $100 discount is $269 for the first person and $199 for additional people from the same agency.  

We have a Temporary Link to the Final Rule because the final rule will not be published in the Federal Register until November 5^th.

https://s3.amazonaws.com/public-inspection.federalregister.gov/2015-27931.pdf

We developed a free 10 minute video that could help you to solve 5 major issues impacting your home health agency.  We have always tried to have our clients, seminar attendees and friends to learn to think outside the box.  This video really hits on that point.  Watch the video and let us know your opinion.

For more information please use the following link

https://youtu.be/NeU5PPcrqz4

CMS Establishes New G Codes For Home Health and Hospice - 10/21/2015

On October 16, 2015 CMS issued MLN Matters Number MM9369.  It has added two new codes for RN and LVN/LPN visits.  This will retire the HCPCS code G0154 and replace it with new RN Code G0299 and the new LVN/LPN code G0300 for episodes that begin on or after 1/1/2016.  This change is taking place because of the change in the reimbursement payment amount for the Hospice Service Intensity Add-On payment for skilled visits provided by an RN or MSW in the last seven days of a patients life.

For more information please use the following link

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9369.pdf

Hospice Should Prepare For New Payment Types and Rates Janaury 2016 - 10/8/2015

The payment system will change beginning January 1, 2016.  The National Routine Home Care Rate for days 1 to 60 will be $183.17 and the National Routine Home Care Rate for days 61+ will be $143.94.  Remember that these rates will be adjusted to the wage index based on where the patient resides.  You will also have to bill RN’s separate from LPN/LVN’s and utilize 15 minute billing increments.  We will certainly have more instructions from CMS regarding hospice billing. 

The new payment rules and rate for 2016 defined a hospice episode of care and how that impact the counting of hospice days.  We recommend you work with your software vendors to ensure they can tract your episodes of care correctly, be able to bill the appropriate code and rate beginning January 1, 2016, and be able to bill the Services Intensity Add-on Payment for the last seven days of a patient’s life.

In case you missed the hospice payment rules for FY 2016 we have attached a link below:

http://www.gpo.gov/fdsys/pkg/FR-2015-08-06/pdf/2015-19033.pdf

US Supreme Court Refuses Stay Overtime Rules - 10/7/2015

On October 6, 2015 the United States Supreme Court Chief Justice John Roberts refused to issue a stay of the Department of Labor (DOL) overtime rules that impact home health workers.  It is expected that the new DOL rules will go into effect on October 13^th.

This rule placed restriction by not allowing home health care workers employed by a third party to qualify for the companionship exemption.  This requires home health agencies to pay overtime for all caregivers paid on an hourly basis and who do not quality as exempt salary employees. 

On September 14^th the DOL stated the ruling would go into effect on October 13, 2015.  They also stated that they would exercise prosecutorial discretion in determining whether to bring enforcement actions through December 31, 2015.  This is not a promise by the DOL not to enforce the rules until that date.  The enforcement is up to the DOL based on how the individual companies have made good faith efforts to bring their compensation programs into compliance with the law.

We recommend you immediately plan to comply with the above ruling.  We do not believe you should wait, since failure to comply could place a substantial financial risk on your company. 

OIG Allows Introductory Visits For Home Health - 10/6/2015

An OIG Advisory Opinion Number 15-12 issued on August 6, 2015 a letter to a home health agency approving their request to furnish non-medical introductory visits.  This visit can only be done after the home health agency has been selected by the patient. Per the letter the Introductory Visits is to facilitate the patient’s transition to home health services in an effort to increase compliance with the post-acute treatment plan.

The Introductory visit is performed by a Liaison of the home health agency.  The Liaison would probably be an LPN.  This visit is limited to the following.  (1) Provide an overview of the home health experience. (2) Give the patient written materials that list the contact information for some of the agencies administrative and clinical employees. (3) Shares pictures of members of the agencies care team who will furnish home health services.

The Liaison does not provide any type of diagnostic or therapeutic services reimbursed by Federal health care programs during the the Introductory Visit, and does not leave any other items or materials with the patient.  This is non covered visit for billing Medicare or Medicaid.

For more information:

http://oig.hhs.gov/fraud/docs/advisoryopinions/2015/AdvOpn15-12.pdf

CMS prohibits contractors from adding new denial reasons on first and second level of appeals 9/15/2015

CMS issued MLN Matters SE1521 limited the scope of review on redeterminations and reconsideratons of certain claims. This impacts claims from physicians, providers including home health & hospice, and suppliers who submit claims to Medicare Administrative Contractors (MACs) for services provided to Medicare Beneficiaries.  It has be published by CMS to inform providers of the clarification CMS has given to MACs and Qualified Independent Contractors (QICs) regarding scope of review for redeterminations (Techmical Direction Letter-15407).  This updated instructions applies to redetermination request received by a MAC or QIC on or after August 1, 2015 and will not be applied retroactively.

For redeterminations and reconsiderations of claims denied following a post-payment review or audit, CMS has instructed MACs and QICs to limited their review to the reason(s) the claim or line item at issued was initially denied.  This means they cannot add additional reasons for denial of claims after the initial denial.  This probably means the denial will now include more reasons for the denial, but it appears to be a step in the right direction.

Link:

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1521.pdf

Home Health Value Based Purchasing Model Demonstration Starts January 1, 2016 - 9/3/2015

The Home Health Value Based Purchasing (HHVP) Model Demonstration will begin on January 1, 2016 in nine states.  The state are Massachusetts, Maryland, North Carolina, Florida, Washington, Arizona, Iowa, Nebraska, and Tennessee.  This demonstration will require all Medicare certified home health agencies in those nine states to participate.  Unfortunately agencies in those states are really participating in the program now, because the base year for the HHVP is 2015.  This will be one of the largest changes ever for home health agency Medicare payments.

Medpac the Medicare Payment Advisory Commission issued comments on August 18, 2015 on the HHVP.  Medpac has been historically critical of home health.  They constantly seem to look for deeper cuts in Medicare reimbursement for home health.  This report actually states it believe that CMS has gone too far on the number of measures in the HHVP.  They recommend CMS reduce the number of measures.  They also would like CMS to focus more on actual scores and focus less on improvement.

The final rules are due to be reported by October 31, 2015.  This may have some changes to the HHVP.  This will only provide a 60 day notice to the home health agencies in the nine states that are required to participate in the program.  We have decided to hold two one day seminars titled “Winning Strategies – Home Health Value Based Payments”.  This seminar will be held on November 10^th in Louisville, KY and November 17^th in Orlando, FL.  We will discuss the final rules and their impact on the home health value based purchasing model, How to succeed under HHVP, Review the final home health rules and rates for 2016, and SMART marketing to grow and prosper.  We hope to see you at one of the seminars.

To view the Medpac Report go to:

http://www.medpac.gov/documents/comment-letters/medpac-comment-on-cms's-proposed-rule-on-the-home-health-prospective-payment-system.pdf?sfvrsn=0