CMS Corrects Technical Errors Related To Hospice Quality Reporting Program

The April 30, 2015 publication of the Federal Register will include corrections to the hospice quality program. The two changes include an omission and a date of correction related to the CAHPS hospice survey.

The corrections are the following:

“On page 50492, in Table 8, we omitted the description of a quality reporting measure “Providing Support for Religious and Spiritual Beliefs”. We are adding the omitted measure to the table.

On Page 50493, in Table 9, we listed an incorrect deadline for the “Monthly data collection April-June 2015 (Q2).” We inadvertently provided November 1, 2015 as the deadline. We are correcting this error to reflect the correct monthly data collection deadline date of November 11, 2015.”

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CDC Report: Nurses, Assistants Most Injury-Prone In Healthcare

According to a new report by the CDC, nurses and nursing assistants have the most dangerous and injury-prone jobs. The CDC report reveals that nurses and nursing assistants accounted for nearly 60% of all identified OSHA-recordable injuries from 2012 to 2014. These injuries are typically caused by a number of factors, including overweight/obese and acutely ill patients, high patient-to-nurse ratios, long shifts, and efforts to mobilize patients almost immediately after medical interventions. Between 2012 and 2014, 4,674 out of 10,680 injuries involved patient handling and movement. Workplace violence rates have also nearly doubled for nurses and nurse assistants. In order to mitigate injuries, the CDC advises using lifting equipment, proper training, and establishing a safety culture that emphasizes continuous improvement.

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Senators Hold Hearing On Reducing Medicare Appeals Backlog

The U.S. Senate Finance Committee held a hearing on how to make the Medicare audits and appeals process more efficient. Currently, the Medicare appeals system is backlogged with at least 500,000 cases pending review. During the hearing, Senators heard testimony from three witness – each representing a different level of appeal.

Some Senate members raised concern about the fact that the majority of payment appeals are found in favor of the defendant. High rates of reversals, they said, raises questions about “how the initial decisions are being made and whether providers and beneficiaries are facing undue burdens on the front end.”

From NAHC:

“In its 2015 Regulatory Blueprint for Action, the National Association for Home Care & Hospice (NAHC) provides recommendations to eliminate delays in Medicare Appeals to ALJs.  NAHC recommends that: 1) CMS take all necessary steps to improve the quality and accuracy of initial claim determinations to limit need for an administrative appeal; 2) CMS monitor its contractors that handle early-stage administrative appeals to ensure a high degree of accuracy and to reduce the number of appeals that end up before an ALJ; 3) CMS provide a settlement option to all appellants with claims pending before an ALJ in order to reduce the backlog. That settlement should be based on historical data on ALJ reversal rates and the cost savings achieved by Medicare coming through the avoidance of an ALJ appeal; 4) OMHA increase its resources to handle the level of demand and establish alternative dispute resolution processes to resolves some appeals.”

Click here to read more from NAHC.

CMS Clarifies Ordering & Certifying Documentation Requests

CMS has issued Change Request (CR) 9114 that provides instructions and clarification on their existing policy for ordering and certifying maintenance requirement.

In May 2010, CMS issued an interim final rule (CMS-6010-IR) and on April 27, 2012, a final rule (CMS-6010-F) which established Medicare Ordering and Referring, and Documentation Maintenance Requirements.

CMS required that any provider and supplier that furnishes covered home health services, items of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS), clinical laboratory, or imaging services, is required to maintain documentation for 7 years from the date of service, and that the provider give access to that documentation upon request. This requirement also applied to a physician ordering/certifying home health services, items of DMEPOS, clinical laboratory, or imaging services.

In the CR, CMS clarifies the term “access to documentation” to mean that the documentation is actually provided or made available in a the manner requested by CMS or a Medicare contractor. CMS provides examples of sufficient and deficient access to documentation in the CR.

Click here to view the CR.

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Tiptastic Tuesday: CMS Reminds Providers About New Survey Appeals Process

CMS has reminded state survey agency directors that it will no longer accept appeals through “the U.S. mail from providers that disagree with actions imposed on their facilities.” Providers must electronically file a hearing request using the Departmental Appeals Board e-filing system. Providers must also register on the DAB website.

Petitioners without access to the Internet or a computer may request a waiver from e-filing if they call the Civil Remedies Division at (202) 565-9462 and explain why.

The change became effective on October 1, 2014.

Click here to see the CMS memo.

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Monday Morning Recap

The HMS Healthcare Management Solutions Monday Morning Recap reviews some of the top stories and healthcare highlights you may have missed last week.

May 7 Online Forum Will Explain New Home Health Rating System

CMS is holding a one-hour, web-based open door forum on May 7 at 1:30-2:30 p.m. EST to explain the new set of star ratings for the Home Health Compare website. CMS will use the Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) survey results to create Patient Survey Star Ratings for the Home Health Compare website.  The forum will describe the rationale and overview of the patient survey star ratings.

Click here to read more.