Attention Home Health Agencies: Manual Updates To Clarify Requirements For Physician Certification & Recertification

CMS has released manual updates to clarify requirements for physician certification and recertification of patient eligibility for home health services.

“Change Request (CR) 9119 manualizes policies discussed in the Calendar Year (CY) 2015 Home Health Prospective Payment System (HH PPS) Final Rule published on November 6, 2014. CR 9119 instructs MACs to be aware of the revisions to the requirements for physician certification and recertification of patient eligibility for Medicare home health services. MACs are also instructed to be aware of the revised timeframe for therapy functional reassessments. Make sure that your billing staffs are aware of these changes.”

Click here for more info from CMS.

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Attention Home Health Agencies: PEPPER Update Session Scheduled

As we previously reported, the TMF Health Quality Institute is developing a new Program for Evaluating Payment Patterns Electronic Report (PEPPER) for Home Health Agencies (HHA). It will be available this July.

TMF Health Quality Institute has provided the following details regarding a PEPPER update session on April 30:

When: Thursday, April 30 at 11:00 a.m. to 12:30 p.m. Central Daylight Time

What: A WebEx presented by Kimberly Hrehor with TMF Health Quality Institute

Topic: An update on what is new/changed in the Q4FY14 PEPPER for Skilled Nursing Facilities (SNFs), Long-term (LT) Acute Care Hospitals, Inpatient Rehabilitation Facilities (IRFs) and Hospices, and a preview of the Home Health Agency PEPPER (coming in July 2015).

Registration is not required! Use this link to join the event:

https://tmfpepper.webex.com/tmfpepper/onstage/g.php?d=923918378&t=a

Event number: 923 918 378

Event password: lantana

This program is being brought to you at no charge.

Handout: Will be posted on the PEPPERresources.org website on the applicable Training and Resources pages by April 29, 2015.

Click here for more information.

Home Health Star Rating System Begins In July

CMS has announced plans to implement a five star rating system for home health agencies on the Home Health Compare website starting in July 2015. The Home Health Compare (HHC) Star Rating includes nine of the 22 currently reported process and outcome quality measures. These measures include three process measures, five outcome measures, and one claims based measure. The methodology for calculating “is based on a combination of individual measure rankings and the statistical significance of the difference between the performance of an individual HHA on each measure and the performance of all HHAs.” These quality measure values for HHAs are compared to the national agency median with their rating adjusted to reflect the differences relative to other agencies’ quality measure values. The adjusted ratings are then combined into one overall HHC Star Rating that summarizes each of the nine individual measures.

Please note, CMS is sponsoring a webinar to review the format of the report and the process for requesting review of the HHC rating on March 26, 2015, at 1 p.m. ET. Click here to register for this webinar.

Click here to view frequently asked questions on the HHC Star Rating System.

Click here to read more.

 

PEPPER To Be Available For Home Health Agencies

Home Health Agencies (HHAs) will have a “free” tool available to help them assess their risk of improper Medicare payments beginning July 2015. TMF Health Quality Institute is developing a new Program for Evaluating Payment Patterns Electronic Report (PEPPER) for HHAs. PEPPER is an educational tool to help providers proactively monitor their claims and work to prevent improper Medicare payments. It summarizes an HHA’s Medicare claims data in areas that may be at risk for improper Medicare payments and compares the HHA’s statistics with aggregate statistics for the nation, MAC jurisdiction and the state. If a provider’s statistics are at or above the national 80th percentile, the provider is identified as an “outlier” and may be at risk for improper Medicare payments.

Click here to read more.

Attention Home Health Agencies: CMS Has Issued CR 9027

CMS has issued Change Request (CR) 9027 to notify providers of new edits in Original Medicare systems to ensure Low Utilization Payment Adjustment (LUPA) payments under the Home Health Prospective Payment System (HH PPS) are made appropriately. CR 9027 clarifies billing instructions for HH PPS claims. Please note, no new policy is created by CR 9027 – these new requirements improve the enforcement of existing Original Medicare payment policies. Make sure your billing staff is aware of these changes.

Click here for more information.

NAHC Completes Its 2015 Legislative Blueprint

Every year, the policy staff at NAHC develops its Legislative Blueprint for the coming year. This year’s Legislative Blueprint has been completed. To help develop these blueprints, NAHC’s policy staff sought input from the organization’s Membership and affiliated organizations. As issues develop throughout the year, NAHC gathers additional ideas for these agendas from members, state association affiliates, advisory committees, and the NAHC Board of Directors. With big changes on the legislative and regulatory horizon this year for Capitol Hill, NAHC is planning ahead with strategies to protect the continued viability of home care and hospice.

Click here to view NAHC’s 2015 Legislative Blueprint for Action, as well as Blueprints from past years.

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CMS Develops Pilot Program To Better Estimate Home Health Agency Fraud

CMS is developing a pilot program to determine how many Medicare fraud cases are taking place in home health agencies. A contractor search is currently underway to help implement the new initiative. Many Medicare fraud experts are commending the endeavor, believing the move to be positive in an industry with long-standing allegations of fraud.

Between 2010 and 2014, there were nearly $1 billion in improper Medicare payments and fraud identified relating to the home health benefit, according to the OIG. Statistically valid estimates of the rate of fraud in Medicare does not currently exist for home health agencies. The new contractor will focus on developing a methodology to estimate the extent of probable fraud of home health agencies in the Medicare fee-for-service program. The initial pilot will focus on agencies in Florida, which accounted for $2.1 billion of total Medicare home health spending in 2013.

Contractors will begin by reviewing 130 home health claims in the Miami-Dade County area. As part of the review process, the contractor will interview beneficiaries and their medical providers and make unannounced visits to the offices of onsite home health agencies. Any formed methodology is expected to be replicated later for a larger, nationwide program. CMS hopes the new initiative will help it better allocate its resources.

Click here to read more.