CMS Issues Change Request 8969

CMS has issued Change Request (CR) 8969 that provides instructions to the claims processing contractors on the home health prospective payment system (HHPPS) rate updates for CY 2015. The transmittal “instructs contractors on the system changes necessary to implement the changes to the Market Basket Update; National, Standardized 60-Day Episode Payment; National Per-Visit Rates; Low-Utilization Payment Adjustment Add-On Payments; Non-Routine Supply Payments, and Rural Add-on.”

CMS has included tables outlining the changes made to each of the component parts of the HHPPS and payment amounts associated with the 2 percent reductions for agencies that do not comply with the quality reporting requirements. Included also is a complete list of the old and new wage index amounts for rural and urban designations, and the transition wage index amounts that will be applied in 2015.

Please note,  the CY 2015 HHPPS payment rates will be applied to episodes with claim statement “Through” date on or after January 1, 2015, and on or before December 31, 2015.

Click here to view the CR.

Click here to read more from NAHC.

CMS To Host A National Provider Call On New F2F Encounter Requirements

CMS announced a National Provider Call on the new F2F encounter requirements to be held on December 16, 2014. The National Provider Call will provide an overview of certifying patient eligibility for the Medicare home health benefit, including an overview of a new requirement for home health agencies to obtain documentation from the certifying physicians’s or the acute/post-acute facility’s medical record for the patient that serves as the basis for the certification of patient eligibility.

The new requirement was finalized in the Calendar Year 2015 Home Health Prospective Payment System final rule, effective for home health episodes beginning on or after January 1, 2015.

To register for this MLN Connects Call National Provider Call, click here.

Click here to read more.

Final Rule Fails To Promote Home Health EHRs

The final rule for the Medicare home health prospective payment system for CY 2015 includes language on the use of electronic health records by home health agencies. In the final rule, CMS says that the Department of Health and Human Services (HHS) will continue to promote the adoption and implementation of certified EHRs but doesn’t explicitly state that HHS encourages their use in a home health setting.

Last month, the proposed rule on Medicare and Medicaid Conditions of Participation for Home Health Agencies encouraged “home health providers to use-and their health IT vendors to develop-ONC-certified HIT/EHR technology to support interoperable health information exchange with physicians, hospitals, other long-term and post-acute care providers, and their patients.” The final rule also states that the ONC expressed in the 2014 Edition Release 2 final rule an intention to propose future changes to the ONC HIT Certification Program that would permit the certification of health IT for other health care settings, including long term and post acute care and behavioral health settings.

In a meeting of the HIT Policy Committee’s certification and adoption workgroup, the Pennsylvania Homecare Association (PHA) submitted a written comment which argued for the establishment of voluntary EHR certification criteria. PHA representatives stated that even if these criteria were put in place, EHR adoption among home health providers could start to “level off or even decrease” since they are not eligible for the monetary and technical assistance provided under the HITECH Act.

Click here to see the final rule.

Click here to read more.

CMS Announces 2015 Medicare Payment Changes For Home Health Agencies

CMS has announced changes to the Medicare home health prospective payment system (HH PPS) for CY 2015 to increase efficiency, flexibility, payment accuracy, and improved quality.

CMS projects that Medicare payments to home health agencies in CY 2015 will be reduced by 0.30 percent, or $60 million. This decrease reflects the effect of the 2.1 percent home health payment update percentage ($390 million increase) and the second year of the four-year phase-in of the rebasing adjustments to the national, standardized 60-day episode payment rate, the national per-visit payment rates, and the non-routine medical supplies (NRS) conversion factor (2.4 percent or $450 million decrease).

Notable changes:

  • CMS is eliminating the physician narrative requirement for F2F.
  • CMS will require physicians to have sufficient documentation in their own files to support the certification of homebound status and skilled care need. CMS will allow agencies to provide their record to the certifying physician so it can be included in considering if sufficient documentation exists to support the certification. CMS has also modified the rule to require that certifying physicians submit their records to agencies whenever a claim is audited for compliance.
  • Rate rebasing will continue with an $80.95 base episode reduction offset by a 2.1% inflation update (2.6 MI minus 0.5 productivity adjustment) along with the second year adjustments to LUPA and NRS rates. The productivity adjustment is 0.1% greater than proposed leading to a slightly lower inflation update.

Click here to view the final rule. This link will change once it is published in the Federal Register on November 6, 2014.

Click here for additional information about the Home Health Prospective Payment System.

More cuts ahead for Home Health Providers, according to national experts

Representatives from 3 leading home health organizations are reporting that CMS’s proposed HHPPS rule would reduce Medicare Home Health funding by 3.5% each year from 2014 to 2017, resulting in a 14% cut in reimbursement, or $22 billion over ten years. This is on top of $72.5 billion in Medicare cuts already imposed by other legislative or regulatory changes.

Click here to read more.