1142014

1

Home Health Regulatory Review

Presented by

Deanna Loftus

Director of Regulatory Compliance

January 2014

Webinar Agenda

bull ICD-10 Update

bull Updated OASIS C-1 Proposed Rule bull 2014 PPS Proposed RulePayment Update

bull HETS Eligibility Transition Update

bull Home Health Compare

bull Jimmo v Sebelius Settlement Agreement

bull Home Health Audits Edits and Billing Changes

PECOS Edits Are Now in Effect

bull Potential Changes on the Horizon

Upcoming MedPac Recommendations

bull Medicare Administrative Contractors

1142014

2

ICD-10 Update

bull Tabular and index of ICD-10-CM

bull Addenda (changes since the 2012 version)

bull Complete list of ICD-10-CM code titles ndash long and

abbreviated

bull General Equivalence Mappings

bull Reimbursement Mappings

bull Duplicate ICD-9-CM and ICD-10-CM codes

httpcmshhsgovMedicareCodingICD102013-ICD-10-PCS-GEMshtml

ICD-10 Files

1142014

2

ICD-10 Update

bull Tabular and index of ICD-10-CM

bull Addenda (changes since the 2012 version)

bull Complete list of ICD-10-CM code titles ndash long and

abbreviated

bull General Equivalence Mappings

bull Reimbursement Mappings

bull Duplicate ICD-9-CM and ICD-10-CM codes

httpcmshhsgovMedicareCodingICD102013-ICD-10-PCS-GEMshtml

ICD-10 Files

1142014

3

Start Preparing for ICD-10 NOW

httpappswhointclassificationsicd10browse2010en

httpcmshhsgovMedicareCodingICD10indexhtml

httpwwwcmsgovMedicareCodingICD10DownloadsICD-

10Overviewpdf

Training and Preparedness Materials

bull Get to know your top 25 diagnoses in your agency

bull Learn the documentation requirements for these

diagnoses first

Training and Preparedness Materials Cont

1142014

4

bull CMS announced in December

bull Was created to generate awareness and interest and

instill confidence in the provider community that CMS

and the MACs are ready for ICD-10

bull Scheduled for the week of March 3rd ndash 7th

httpwwwcmsgovOutreach-and-EducationMedicare-

Learning-Network-

MLNMLNMattersArticlesDownloadsMM8465pdf

ICD-10 Testing Period Announced

OASIS C-1

1142014

5

OASIS C-1

bull Changes needed to support ICD-10

bull Currently under its second proposal with

comment period ending in December

bull Implementation date would be Oct 1 2014 httpwwwcmsgovRegulations-and-

GuidanceLegislationPaperworkReductionActof1995PRA-Listing-

ItemsCMS-R-

245htmlDLPage=1ampDLFilter=oasisampDLSort=1ampDLSortDir=descending

OASIS C-1 Cont

1142014

6

OASIS C-1 Cont

OASIS C-1 Cont

1142014

7

OASIS C-1 Cont (Wording Changes)

Text change from ldquoierdquo to ldquofor examplerdquo

bull M0150 ndash Response numbers 6 and 7 text

bull M1100 ndash Living arrangement c change from ldquoierdquo to ldquofor examplerdquo and

additional wording ldquoresidential care homerdquo added to end of description

bull M1300 ndash responses 1 and 2

bull M1400 ndash responses 2 and 3

bull M1510 - responses 2 and 5 have changed from ldquoierdquo to ldquofor examplerdquo item

description change ldquosince the previous OASIS assessmentrdquo was changed to ldquoat

the time of or at any time since the previous OASIS assessmentrdquo

bull M1700 ndash response 2

bull M1740 ndash response 2

bull M1890 ndash response 1

bull M2000 ndash item description 1 has changed from ldquo ierdquo to ldquofor examplerdquo and adds

additional words in two separate places ldquosignificantrdquo and ldquo[non-adherence]rdquo

bull M2310 ndash responses 3 and 5 have changed from ldquo ierdquo to ldquofor examplerdquo the

item description has ldquoseek andorrdquo added and response number 1 is completely

reworded

bull M2430 ndash Responses 3 and 5 have a change from ldquo ierdquo to ldquofor examplerdquo

OASIS C-1 Cont (Wording Changes Cont)

Text change from ldquoierdquo to ldquospecificallyrdquo

bull M1610 ndash Response 2

bull M1800 ndash Item description

bull M1860 ndash Response 0

bull M1880 ndash Response 0 (b)

bull M1900 ndash Grid responsefirst column (a) has change from

ldquoierdquo to ldquospecificallyrdquo and adds the text ldquoand toileting hygienerdquo

1142014

8

OASIS C-1 Cont (Wording Changes Cont)

M Item Changing

bull M01010 ndash Item is changing to M1011 item description changing to state ICD-10 and V

W X Y or Z codes a new response of NA was added

bull M102010221024 ndash Items changing to M102110231025 descriptioninstruction

wording almost completely updated for ICD-10 and new M item response numbers

(Make sure to note changes to columns 2 3 4 under Diagnosis row Description row

and Primary Diagnosis row)

bull M01032 ndash Item is changing to M1033 item description remains the same but the

wording of the responses are different and more responses exist now (CMS stated this

was revised to collect data on factors that have been identified in the literature as

predictive of hospitalization and to order responses based on length of the appropriate

look-back period)

bull M1040 ndash Item is changing to M1041 item description changes and response wording

changes

bull M1045 ndash Item is changing to M1046 item description changes response wording

changes and one additional response added

bull M1050 ndash Item is changing to M1051 item description changes and response wording

changes

bull M1055 ndash Item is changing to M1056 item description changes response wording

changes and item has one less response now

bull M2100 ndash Item is changing to M2102 one of the columns is being eliminated the

column descriptions have been revised responses a ndash d and f have been updated to

change ldquoierdquo to ldquofor examplerdquo responses e and g have been updated to change

ldquoincludesrdquo to ldquofor examplerdquo

OASIS C-1 Cont (Wording Changes Cont)

Miscellaneous Text Changes

M1306 ndash ldquo(EXCLUDES Stage I pressure ulcers and healed Stage II ulcers)rdquo added to

the end of the description

M1308 - ldquo(EXCLUDES Stage I pressure ulcers and healed Stage II ulcers)rdquo added to

the end of the description one of the response columns was removed at all timepoints

and the remaining column title is reworded CMS stated this change was for increased

harmonization and added a new item to take the place of the removed column

information (See new item section)

M1334 ndash 0 response removed

M1340 ndash Wording of 1 and 2 responses revised to show different questions to goto

next

M1910 ndash Item description completely changes wording of all three (0 1 2) responses

completely changes

M2004 ndash Almost the entire description is revised the end of NA response is revised

M2015 ndash Two additional words added to the item description ldquoadverserdquo and

ldquosignificantrdquo

M2040 ndash Part of the item description was updated to change from ldquoprior to the current

assessmentrdquo to ldquoprior to hisher most recent illnessrdquo

M2250 ndash The Not Applicable column response descriptions for responses b ndash g have

been almost completely revised

M2300 ndash Item description has been almost completely revised

M2400 ndash The item description has been revised the not applicable response column

for all responses have had wording description revisions

1142014

9

OASIS C-1 Cont (New Item at Discharge)

bull M1309 Worsening in Pressure Ulcer Status

since SOCROC was added to collect

information on worsening pressure ulcer

status using wording harmonized with the

MDS and CARE instruments

OASIS C-1 Cont (Items deleted at Discharge)

bull Item M1350 reports whether the patient has a

skin lesion or open wound that is receiving

intervention from the home health agency other

than a surgical wound pressure or stasis ulcer

bull Item M1410 reports the types of respiratory

treatments (oxygen ventilator etc) the patient is

receiving at home

bull Item M2110 reports how frequently the patient

receives assistance with activities of daily living

from caregivers other than the home health

agency

1142014

10

OASIS C-1 Cont (Items deleted at all Timepoints)

bull Item M1012 Inpatient Procedures

bull Items M1310 M1312 and M1314 which report

the length width and depth of the pressure ulcer

with the largest surface dimension

bull Item M2440 - Reason patient was admitted to a

nursing facility Collected at the time of transfer

from home health to a skilled nursing facility

OASIS C-1 Cont

bull Draft OASIS data Specifications v2100 were also

recently announced|

bull Submission format change also as of Oct 1 2014 httpwwwcmsgovMedicareQuality-Initiatives-Patient-Assessment-

InstrumentsOASISDataSpecificationshtml

1142014

7

OASIS C-1 Cont (Wording Changes)

Text change from ldquoierdquo to ldquofor examplerdquo

bull M0150 ndash Response numbers 6 and 7 text

bull M1100 ndash Living arrangement c change from ldquoierdquo to ldquofor examplerdquo and

additional wording ldquoresidential care homerdquo added to end of description

bull M1300 ndash responses 1 and 2

bull M1400 ndash responses 2 and 3

bull M1510 - responses 2 and 5 have changed from ldquoierdquo to ldquofor examplerdquo item

description change ldquosince the previous OASIS assessmentrdquo was changed to ldquoat

the time of or at any time since the previous OASIS assessmentrdquo

bull M1700 ndash response 2

bull M1740 ndash response 2

bull M1890 ndash response 1

bull M2000 ndash item description 1 has changed from ldquo ierdquo to ldquofor examplerdquo and adds

additional words in two separate places ldquosignificantrdquo and ldquo[non-adherence]rdquo

bull M2310 ndash responses 3 and 5 have changed from ldquo ierdquo to ldquofor examplerdquo the

item description has ldquoseek andorrdquo added and response number 1 is completely

reworded

bull M2430 ndash Responses 3 and 5 have a change from ldquo ierdquo to ldquofor examplerdquo

OASIS C-1 Cont (Wording Changes Cont)

Text change from ldquoierdquo to ldquospecificallyrdquo

bull M1610 ndash Response 2

bull M1800 ndash Item description

bull M1860 ndash Response 0

bull M1880 ndash Response 0 (b)

bull M1900 ndash Grid responsefirst column (a) has change from

ldquoierdquo to ldquospecificallyrdquo and adds the text ldquoand toileting hygienerdquo

1142014

8

OASIS C-1 Cont (Wording Changes Cont)

M Item Changing

bull M01010 ndash Item is changing to M1011 item description changing to state ICD-10 and V

W X Y or Z codes a new response of NA was added

bull M102010221024 ndash Items changing to M102110231025 descriptioninstruction

wording almost completely updated for ICD-10 and new M item response numbers

(Make sure to note changes to columns 2 3 4 under Diagnosis row Description row

and Primary Diagnosis row)

bull M01032 ndash Item is changing to M1033 item description remains the same but the

wording of the responses are different and more responses exist now (CMS stated this

was revised to collect data on factors that have been identified in the literature as

predictive of hospitalization and to order responses based on length of the appropriate

look-back period)

bull M1040 ndash Item is changing to M1041 item description changes and response wording

changes

bull M1045 ndash Item is changing to M1046 item description changes response wording

changes and one additional response added

bull M1050 ndash Item is changing to M1051 item description changes and response wording

changes

bull M1055 ndash Item is changing to M1056 item description changes response wording

changes and item has one less response now

bull M2100 ndash Item is changing to M2102 one of the columns is being eliminated the

column descriptions have been revised responses a ndash d and f have been updated to

change ldquoierdquo to ldquofor examplerdquo responses e and g have been updated to change

ldquoincludesrdquo to ldquofor examplerdquo

OASIS C-1 Cont (Wording Changes Cont)

Miscellaneous Text Changes

M1306 ndash ldquo(EXCLUDES Stage I pressure ulcers and healed Stage II ulcers)rdquo added to

the end of the description

M1308 - ldquo(EXCLUDES Stage I pressure ulcers and healed Stage II ulcers)rdquo added to

the end of the description one of the response columns was removed at all timepoints

and the remaining column title is reworded CMS stated this change was for increased

harmonization and added a new item to take the place of the removed column

information (See new item section)

M1334 ndash 0 response removed

M1340 ndash Wording of 1 and 2 responses revised to show different questions to goto

next

M1910 ndash Item description completely changes wording of all three (0 1 2) responses

completely changes

M2004 ndash Almost the entire description is revised the end of NA response is revised

M2015 ndash Two additional words added to the item description ldquoadverserdquo and

ldquosignificantrdquo

M2040 ndash Part of the item description was updated to change from ldquoprior to the current

assessmentrdquo to ldquoprior to hisher most recent illnessrdquo

M2250 ndash The Not Applicable column response descriptions for responses b ndash g have

been almost completely revised

M2300 ndash Item description has been almost completely revised

M2400 ndash The item description has been revised the not applicable response column

for all responses have had wording description revisions

1142014

9

OASIS C-1 Cont (New Item at Discharge)

bull M1309 Worsening in Pressure Ulcer Status

since SOCROC was added to collect

information on worsening pressure ulcer

status using wording harmonized with the

MDS and CARE instruments

OASIS C-1 Cont (Items deleted at Discharge)

bull Item M1350 reports whether the patient has a

skin lesion or open wound that is receiving

intervention from the home health agency other

than a surgical wound pressure or stasis ulcer

bull Item M1410 reports the types of respiratory

treatments (oxygen ventilator etc) the patient is

receiving at home

bull Item M2110 reports how frequently the patient

receives assistance with activities of daily living

from caregivers other than the home health

agency

1142014

10

OASIS C-1 Cont (Items deleted at all Timepoints)

bull Item M1012 Inpatient Procedures

bull Items M1310 M1312 and M1314 which report

the length width and depth of the pressure ulcer

with the largest surface dimension

bull Item M2440 - Reason patient was admitted to a

nursing facility Collected at the time of transfer

from home health to a skilled nursing facility

OASIS C-1 Cont

bull Draft OASIS data Specifications v2100 were also

recently announced|

bull Submission format change also as of Oct 1 2014 httpwwwcmsgovMedicareQuality-Initiatives-Patient-Assessment-

InstrumentsOASISDataSpecificationshtml

1142014

8

OASIS C-1 Cont (Wording Changes Cont)

M Item Changing

bull M01010 ndash Item is changing to M1011 item description changing to state ICD-10 and V

W X Y or Z codes a new response of NA was added

bull M102010221024 ndash Items changing to M102110231025 descriptioninstruction

wording almost completely updated for ICD-10 and new M item response numbers

(Make sure to note changes to columns 2 3 4 under Diagnosis row Description row

and Primary Diagnosis row)

bull M01032 ndash Item is changing to M1033 item description remains the same but the

wording of the responses are different and more responses exist now (CMS stated this

was revised to collect data on factors that have been identified in the literature as

predictive of hospitalization and to order responses based on length of the appropriate

look-back period)

bull M1040 ndash Item is changing to M1041 item description changes and response wording

changes

bull M1045 ndash Item is changing to M1046 item description changes response wording

changes and one additional response added

bull M1050 ndash Item is changing to M1051 item description changes and response wording

changes

bull M1055 ndash Item is changing to M1056 item description changes response wording

changes and item has one less response now

bull M2100 ndash Item is changing to M2102 one of the columns is being eliminated the

column descriptions have been revised responses a ndash d and f have been updated to

change ldquoierdquo to ldquofor examplerdquo responses e and g have been updated to change

ldquoincludesrdquo to ldquofor examplerdquo

OASIS C-1 Cont (Wording Changes Cont)

Miscellaneous Text Changes

M1306 ndash ldquo(EXCLUDES Stage I pressure ulcers and healed Stage II ulcers)rdquo added to

the end of the description

M1308 - ldquo(EXCLUDES Stage I pressure ulcers and healed Stage II ulcers)rdquo added to

the end of the description one of the response columns was removed at all timepoints

and the remaining column title is reworded CMS stated this change was for increased

harmonization and added a new item to take the place of the removed column

information (See new item section)

M1334 ndash 0 response removed

M1340 ndash Wording of 1 and 2 responses revised to show different questions to goto

next

M1910 ndash Item description completely changes wording of all three (0 1 2) responses

completely changes

M2004 ndash Almost the entire description is revised the end of NA response is revised

M2015 ndash Two additional words added to the item description ldquoadverserdquo and

ldquosignificantrdquo

M2040 ndash Part of the item description was updated to change from ldquoprior to the current

assessmentrdquo to ldquoprior to hisher most recent illnessrdquo

M2250 ndash The Not Applicable column response descriptions for responses b ndash g have

been almost completely revised

M2300 ndash Item description has been almost completely revised

M2400 ndash The item description has been revised the not applicable response column

for all responses have had wording description revisions

1142014

9

OASIS C-1 Cont (New Item at Discharge)

bull M1309 Worsening in Pressure Ulcer Status

since SOCROC was added to collect

information on worsening pressure ulcer

status using wording harmonized with the

MDS and CARE instruments

OASIS C-1 Cont (Items deleted at Discharge)

bull Item M1350 reports whether the patient has a

skin lesion or open wound that is receiving

intervention from the home health agency other

than a surgical wound pressure or stasis ulcer

bull Item M1410 reports the types of respiratory

treatments (oxygen ventilator etc) the patient is

receiving at home

bull Item M2110 reports how frequently the patient

receives assistance with activities of daily living

from caregivers other than the home health

agency

1142014

10

OASIS C-1 Cont (Items deleted at all Timepoints)

bull Item M1012 Inpatient Procedures

bull Items M1310 M1312 and M1314 which report

the length width and depth of the pressure ulcer

with the largest surface dimension

bull Item M2440 - Reason patient was admitted to a

nursing facility Collected at the time of transfer

from home health to a skilled nursing facility

OASIS C-1 Cont

bull Draft OASIS data Specifications v2100 were also

recently announced|

bull Submission format change also as of Oct 1 2014 httpwwwcmsgovMedicareQuality-Initiatives-Patient-Assessment-

InstrumentsOASISDataSpecificationshtml

1142014

9

OASIS C-1 Cont (New Item at Discharge)

bull M1309 Worsening in Pressure Ulcer Status

since SOCROC was added to collect

information on worsening pressure ulcer

status using wording harmonized with the

MDS and CARE instruments

OASIS C-1 Cont (Items deleted at Discharge)

bull Item M1350 reports whether the patient has a

skin lesion or open wound that is receiving

intervention from the home health agency other

than a surgical wound pressure or stasis ulcer

bull Item M1410 reports the types of respiratory

treatments (oxygen ventilator etc) the patient is

receiving at home

bull Item M2110 reports how frequently the patient

receives assistance with activities of daily living

from caregivers other than the home health

agency

1142014

10

OASIS C-1 Cont (Items deleted at all Timepoints)

bull Item M1012 Inpatient Procedures

bull Items M1310 M1312 and M1314 which report

the length width and depth of the pressure ulcer

with the largest surface dimension

bull Item M2440 - Reason patient was admitted to a

nursing facility Collected at the time of transfer

from home health to a skilled nursing facility

OASIS C-1 Cont

bull Draft OASIS data Specifications v2100 were also

recently announced|

bull Submission format change also as of Oct 1 2014 httpwwwcmsgovMedicareQuality-Initiatives-Patient-Assessment-

InstrumentsOASISDataSpecificationshtml

1142014

10

OASIS C-1 Cont (Items deleted at all Timepoints)

bull Item M1012 Inpatient Procedures

bull Items M1310 M1312 and M1314 which report

the length width and depth of the pressure ulcer

with the largest surface dimension

bull Item M2440 - Reason patient was admitted to a

nursing facility Collected at the time of transfer

from home health to a skilled nursing facility

OASIS C-1 Cont

bull Draft OASIS data Specifications v2100 were also

recently announced|

bull Submission format change also as of Oct 1 2014 httpwwwcmsgovMedicareQuality-Initiatives-Patient-Assessment-

InstrumentsOASISDataSpecificationshtml

1142014

11

CMS Oasis Clarification

bull Make sure your clinical staff is aware

bull CMS updated the guidance on whether the ROC

Comprehensive assessment with OASIS was

completed after the CMS-allowed 48 hour time

frame if all the best practice questions needed to

be answered ldquoNArdquo

httpswwwqtsocomdownloadhhaCMS_OAI_3rd_Qtr_2013_QAs_

10_23_13pdf

Jimmo v Sebelius Settlement Agreement

bull Ask the Contractor Teleconference scheduled for

Jan 21 2014 1pm ndash 2pm

Teleconference Number 800-374-0740

Pass Code 91943405

httpwwwcmsgovMedicareMedicare-Fee-for-Service-

PaymentSNFPPSDownloadsjimmo_fact_sheet2_12052013_finalpdf

1142014

12

2014 HH PPS

Final Rule

httpwwwcmsgovMedicareMedicare-Fee-for-Service-

PaymentHomeHealthPPSHome-Health-Prospective-Payment-System-

Regulations-and-Notices-ItemsCMS-1450-Fhtml

2013 vs 2014 Payment Rates

bull Payments to home health agencies are estimated to decrease by approximately 105 percent or -$200 million in CY 2014

2013 Base Rate Rural Base Rate 2014 Base Rate Rural Base Rate (FINAL)

$213773 $220186 $286927 $295535

1142014

13

2013 vs 2014 Discipline Rates

Discipline 2013 Non-Rural Rural 2014 Non-Rural Rural (FINAL)

HHA $5179 $5334 $5484 $5649

MSS $18331 $18881 $19412 $19994

OT $12588 $12966 $13330 $13730

PT $12503 $12878 $13240 $13637

SN $11435 $11778 $12110 $12473

SLP $13586 $13994 $14388 $14820

note a 2 reduction to these rates when not submitting quality data

2013 vs 2014 Supply Rates

Non-Routine Supply Rates (NRS)

note a 2 reduction to these rates when not

submitting quality data

Severity Level

2013 Non-Rural Rural 2014 Non-Rural Rural (Final)

1 $1456 $1500 $1447 $1491

2 $5258 $5416 $5227 $5383

3 $14416 $14849 $14331 $14761

4 $21419 $22161 $21292 $21930

5 $33029 $34020 $32833 $33813

6 $56806 $58511 $56469 $58163

1142014

14

2013 vs 2014 LUPA Rates

LUPA Add-On Rates

httpwwwcmsgovCenterProvider-TypeHome-Health-Agency-HHA-Centerhtmlredirect=centerhhaasp

note a 2 reduction to these rates when not submitting quality data

2013 Non-Rural Rural 2014 add on factors (Final)

$9585 $9873 SN ndash 18451 PT ndash 16700 SLP ndash 16266

New Quality Measures

bull Added two claims based Home Health Quality

Measures

Re-Hospitalizations

Emergency Department Use

1142014

14

2013 vs 2014 LUPA Rates

LUPA Add-On Rates

httpwwwcmsgovCenterProvider-TypeHome-Health-Agency-HHA-Centerhtmlredirect=centerhhaasp

note a 2 reduction to these rates when not submitting quality data

2013 Non-Rural Rural 2014 add on factors (Final)

$9585 $9873 SN ndash 18451 PT ndash 16700 SLP ndash 16266

New Quality Measures

bull Added two claims based Home Health Quality

Measures

Re-Hospitalizations

Emergency Department Use

1142014

15

Removal of Diagnosis Codes from Case Mix Status

bull Removed 170 Diagnosis Codes from the Grouper

effective January 1 2014

Additional Changes Listed in the Final Rule

bull CMS is proposing a list of several thousand codes that

could carry case-mix status in ICD-10

bull Diagnosis based edits

bull Retirement of Appendix D

1142014

16

Sequestration Still in Effect

bull The 2011 Budget Control Act mandates cuts

equally over 9 years (2013 ndash 2021)

bull Does not apply to Medicaid

Home Health Compare

1142014

17

Home Health Compare

bull Updated in Dec 2013 for the first time since July 2013

bull Was previously delayed due to last years govrsquot

shutdown

bull Jan 2014 quarterly update currently on schedule for

release around Jan 16th

bull HHCAHPS data available now for preview

httpswwwhomehealthcahpsorg

Home Health Compare

1142014

16

Sequestration Still in Effect

bull The 2011 Budget Control Act mandates cuts

equally over 9 years (2013 ndash 2021)

bull Does not apply to Medicaid

Home Health Compare

1142014

17

Home Health Compare

bull Updated in Dec 2013 for the first time since July 2013

bull Was previously delayed due to last years govrsquot

shutdown

bull Jan 2014 quarterly update currently on schedule for

release around Jan 16th

bull HHCAHPS data available now for preview

httpswwwhomehealthcahpsorg

Home Health Compare

1142014

17

Home Health Compare

bull Updated in Dec 2013 for the first time since July 2013

bull Was previously delayed due to last years govrsquot

shutdown

bull Jan 2014 quarterly update currently on schedule for

release around Jan 16th

bull HHCAHPS data available now for preview

httpswwwhomehealthcahpsorg

Home Health Compare

1142014

18

Home Health Compare

HETS Transition

1142014

19

CMS Transitioning Eligibility Systems

CMS is in the process of terminating all Eligibility

systems other than the HETS 270271

bull PPTN and VPIQ

bull Multi Carrier System (MSC) - Discontinued

bull ViPS Medicare System (VMS) - Discontinued

bull FISSDDE

bull HIQAHIQH ndash Will be terminated 472014

bull ELGHELGA ndash Will be terminated 472014

httpswwwcmsgovOutreach-and-EducationMedicare-Learning-Network-

MLNMLNMattersArticlesDownloadsMM8248pdf

httpwwwcmsgovRegulations-and-

GuidanceGuidanceTransmittalsDownloadsR1313OTNpdf

Does HETS Return the Same Eligibility Info

bull Part AB Enrollment info

bull Home Health CertificationsEpisode info

bull Hospice Benefit Period Info

bull MSP information

bull Part D plan number info

bull Medicare Advantage info

bull Etc

httpwwwcmsgovOutreach-and-EducationMedicare-Learning-Network-

MLNMLNMattersArticlesDownloadsSE1249pdf

1142014

20

Audits Edits and Billing Changes

PECOS Edits are Now LIVE

bull Edits are for Home Health Providers

only

bull Edits went live on January 6th

A Physician is required by law to be enrolled in

order to order Home Health and Hospice services

for Medicare patients

bull Use any Reports or Alerts your system offers to

prevent billing rejections

httpwwwcmsgovOutreach-and-EducationMedicare-Learning-Network-

MLNMLNMattersArticlesDownloadsSE1305pdf

1142014

21

PECOS Edits are Now LIVE (Cont)

New 1500 Form Reminder

bull CMS to begin phasing in new form starting in

January 2014

bull Changes include

ldquoSocial Security numberrdquo replaced with ldquoIDrdquo

Addition of item number 21 to identify the

diagnosis code set being reported

httpwwwnuccorg

httpwwwnuccorg5Cimages5Cstories5CPDF5C1500_claim_form_

change_log_2012_02pdf

httpwwwnuccorg5Cimages5Cstories5CPDF5C1500_claim_form_

2012_02pdf

1142014

22

New 1500 Form Reminder (Cont)

bull 1500 Transition Timeline

January 6 2014 Payers can begin receiving and

processing paper claims submitted on the revised

1500 Claim Form (version 0212)

January 6 through March 31 2014 Dual use period

during which payers continue to receive and process

paper claims submitted on the old 1500 Claim Form

(version 0805)

April 1 2014 Payers receive and process paper

claims submitted only on the revised 1500 Claim Form

(version 0212)

Additional HH Reporting Requirements

bull Effective for claims with episodes that begin on or

after July 1

Report the NPI and name of the physician who

certifiesre-certifies the patients eligibility for

home health services if this physician is

different than the physician who signs the

patients plan of care (attending physician)|

Continue to report the NPI and name of the

physician who signs the patients plan of care

httpwwwcmsgovOutreach-and-EducationMedicare-Learning-Network-

MLNMLNMattersArticlesDownloadsMM8441pdf

1142014

23

New Palmetto GBA HH F2F Checklist

httpwwwpalmettogbacompalmettoprovidersnsflsJurisdiction201120Home20Health20and20Hospice~

9F6QB48064opendocumentamputm_source=J11HHHLamputm_campaign=J11HHHLsamputm_medium=email

Special Edition MLN Published for F2F

bull Special Medlearn Matters Article is now available regarding

F2F documentation

httpwwwcmsgovOutreach-and-EducationMedicare-Learning-Network-

MLNMLNMattersArticlesDownloadsSE1405pdf

Late Breaking

News

1142014

24

F2F Clarification Reminder

bull A Home Health Agency (HHA) is permitted to title the face-

to-face encounter document and add the date they received

the signed document if the physician has failed to title the

face-to-face or date hisher signature The HHA may not

alter the face-to-face encounter document in any other way

The HHA must ensure the documentation is complete prior

to submitting the final claim

httpwwwcmsgovMedicareMedicare-Fee-for-Service-

PaymentHomeHealthPPSDownloadsHome-Health-Questions-Answerspdf

REMINDER Widespread Home Health Probe ndash F2F Documentation

bull More comprehensive reviews of claims being

instituted

bull Encouraging providers to review their internal

processes to ensure that all of the criteria for

coverage have been met and documented in the

medical record

httpwwwpalmettogbacompalmettoprovidersnsfDocsCatProviders~Jurisdiction201120Home20Hea

lth20and20Hospice~Articles~Home20Health~97VQKU0732openampnavmenu=||

httpwwwcmsgovOutreach-and-EducationMedicare-Learning-Network-

MLNMLNMattersArticlesdownloadsSE1219pdf

httpwwwcgsmedicarecomhhhpubsnews20130613cope22393html

httpwwwcgsmedicarecomhhhcoverageHospice_FTF_Encounterhtml

1142014

25

Medicare Advantage Plans and HIPPS

bull Edits recently delayed until July 1 2014

Home Health agencies are required to include a

HIPPS code on Medicare Advantage (MA)

claims

CMS instructed the MA plans to communicate

directly with Home Health Providers

Make sure you contact your MA plans

Other Items on the Horizon

1142014

26

Upcoming MedPAC Recommendations

bull Expected to restate last yearrsquos recommendations

Begin a two year rebasing of home health rates and

eliminate the market basket rate

bull New recommendation expected that would penalize Home

Health Agencies with too many patient re-hospitalizations

Regulatory Timeline

bull MedPAC releases report to Congress

Reports are issued in March and June

MARCH ON WASHINGTON

bull Recommendations of the HHS become the 2015 Proposed

Rule

Hospice normally releases in April Home Health in July

Allows for comment period

bull Final Rule is normally published in August for Hospice and

November for Home Health

Hospice Rates take effect October 1 2014

Home Health takes effect January 1 2015

1142014

27

Affordable Care Act Employer Mandate

bull Delayed until January 2015

bull Bill proposed to change definition of full time employees

Forty Hours Is Full Time Act

CMS Home Health and Hospice

Open Door Forums

httpwwwcmsgovOutreach-and-

EducationOutreachOpenDoorForumsODF_HHHDMEhtml

1142014

27

Affordable Care Act Employer Mandate

bull Delayed until January 2015

bull Bill proposed to change definition of full time employees

Forty Hours Is Full Time Act

CMS Home Health and Hospice

Open Door Forums

httpwwwcmsgovOutreach-and-

EducationOutreachOpenDoorForumsODF_HHHDMEhtml

1142014

28

Stay in Tune With Your MAC

Home Health amp Hospice Jurisdictions

Medicare currently has four Jurisdictions assigned for

Home Health and Hospice Administrative Contractors

A map of the regions can be found at httpwwwcmsgovMedicareMedicare-ContractingMedicare-Administrative-

ContractorsDownloadsHomeHealthHospice_JurisdictionMap_OCT2013pdf

It is important for your agency to be up to date with the

instructions from your contractor So make sure you

are signed up for their newsletters and alerts

You can find links to each of the contractors at the

HEALTHCAREfirst Regulatory Blog

1142014

29

Palmetto GBA

httpwwwpalmettogbacomPalmettoProvidersnsfdocsCatJurisdiction201120Home20Health20and20Hospice~Articles~Claims20Processing20Issues20Log

NGS

National Government Services

httpwwwngsmedicarecomwpsportalngsmedicareAllProductionAlerts (not all issues are listed here)

1142014

30

CGS

CGS wwwcgsmedicarecom

httpwwwcgsmedicarecomhhhclaimsfiss_claims_processing_issueshtml (not all issues are listed here)

Stay in the Loop

Bloghealthcarefirstcom

1142014

31

Thank you

For the latest Regulatory News amp Updates

visit HEALTHCAREfirstrsquos Regulatory Blog at

wwwhealthcarefirstcom

For more information about HEALTHCAREfirst

please visit our website or call 8008416095