CMS Posts Hospice HIS Updates & Announces Training For June 17

CMS has scheduled training on the Hospice Item Set (HIS) for Wednesday, June 17 from 1:30pm to 3:00 p.m. EST,

The training will cover updates that were made to the HIS Manual from V1.01 to V.02. Updates to the HIS Manual, and the related HIS training, will provide clarifications of HIS item definitions and expectations for use.

Providers cannot register for the MLN Connects National Provider Call yet. However, instructions for registration will be posted on the MLN National Provider Calls and Events webpage, and on the CMS HQRP HIS website.

Additionally,  CMS posted the HIS Q + A document for the first quarter of 2015. Click here for additional information.

Click here to read more.

OIG Report: Poorly Coded Doctor Claims Cost Medicare $33 Million

A new OIG report has found that more than $33 million Medicare funds might have been overpaid to physicians as a result of poorly coded doctor claims between January 2010 and September 2012. The OIG discovered this after an audit of claims for services physicians performed in ambulatory care centers and other outpatient settings. The coding errors, however, led Medicare contractors to believe they were performed in physicians’ offices or clinics and have been attributed to “internal control weaknesses at the physician billing level and to insufficient post-payment reviews at the Medicare contractor level to identify potential place-of-service billing errors.” So far, most of physicians cited have expressed their intent to refund potential overpayments for incorrectly coded services.

Click here to see the OIG report.

Click here to read more.

CMS Issues Home Health Coverage Manual Updates

CMS has updated the Medicare Benefit Policy Manual, Chapter 7, with Change Request (CR) 9119, relating the requirements for physician certification and recertification. This CR also updates the timeframe required for therapy functional assessments. The CR, however, leaves questions for providers regarding CMS’ expectation for implementing some of the new provisions. NAHC is currently seeking answers from CMS.

CMS states it has eliminated the narrative requirement from the face-to-face (F2F) encounter document. However, the certifying physician is still required to certify that a F2F patient encounter occurred. The encounter document should include the date of the encounter, be related to the primary reason the patient requires home health services, and be performed by an allowed provider type.

In the updated manual revision, CMS affirms a new requirement for documentation that was stated in the 2015 HH PPS Final Rule. When a patient is admitted to home health directly after discharge from an acute or post-acute care setting and the physician who cared for the patient in that setting is the certifying physician, but will not be following the patient after discharge, the certifying physician must identify the community physician who will be following the patient. CMS says the certification must be completed prior to when the home health agency bills Medicare. CMS reiterates that is not acceptable for HHAs to wait until the end of a 60-day episode of care to obtain the completed certification/recertification.

Click here to view CR 9119.

Click here for more detailed information regarding CR 9119 from NAHC.

CMS Delays Requirement That Part D Prescribers Be Enrolled In Medicare Or In Valid Opt-Out Status

CMS has released an interim final rule delaying a regulatory requirement that prescribers of Part D medications that are eligible to enroll in Medicare either be enrolled in Medicare approved status or in a valid opt-out status.

The enrollment requirement was scheduled to go into effect on December 1, 2015 but now will go into effect on January 1, 2016. Furthermore, “in cases where Part D enrollees submit prescriptions for processing through Part D that are not prescribed by an eligible professional that is either enrolled in Medicare in an approved status or is in a valid opt-out status, the Part D plan must provide a provisional prescription (3 month supply) for the Part D enrollee to allow the prescriber time to either enroll in Medicare or to allow the patient time to secure a prescription from another professional.”

Click here to see the regulation.

Click here to read more.

CMS Releases A Proposed Hospice Payment Rule

CMS has released a proposed payment rule for fiscal year (FY) 2016 that address payment reform of the routine home care (RHC) level of care by providing a differential payment of two separate rates. One rate is for care provided from day one through day 60 of an episode of hospice care and another for days 61 and after.

In the proposed rule, CMS also provides for a Service Intensity Add-on (SIA) that would be added to RHC payment for RN and social work visits provided during the last seven days of life. The rule “conveys CMS’ intent to transition the hospice Cap year to the federal fiscal year and implement the alternative method for annual updates to the aggregate Cap mandated by the IMPACT Act, signals CMS’ future intent relative to public reporting of hospice quality data, and clarifies that hospice programs must submit on claims all diagnoses (related or unrelated) of patients under their care.”

NAHC is currently conducting an in-depth analysis of the proposed regulation and its potential impact on hospices.

Click here to see the proposed rule.

Click here for more details from NAHC.

Medicare To Pay Hospices $200 Million More In 2016

CMS is proposing that hospices get a 1.3% rate increase from Medicare in a newly issued rule. The rule means Medicare would spend $200 million more on hospices in 2016 than in 2015.

CMS is also using the rule is clarify how to properly document a diagnosis on claims forms. CMS said it is “concerned that some hospices are neither conducting a comprehensive assessment nor updating the plan of care as articulated by the conditions of participation to recognize the conditions that affect an individual’s terminal prognosis.”

Under the new rule, hospices would be required to report all diagnoses identified in initial and comprehensive assessments on hospice claims – whether they are related or unrelated to the patient’s terminal prognosis.

Click here to read more.

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.”

Click here to read more.