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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.
According to a new report from the Catalyst for Payment Reform, more than half of the $360 billion in Medicare payments made two years ago were based on traditional fee-for-service models without regard to quality or value.
However, as the government moves toward outcomes-based payment models, the number is expected to shrink significantly. The U.S. Department of Health and Human Services (HHS) is pushing to tie at least half of all traditional fee-for-service Medicare payments to quality or value through alternative payment models by the end of 2018.
Click here to read more.
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.
TMF Health Quality Institute, CMS’ contractor for the Program for Evaluation Payment Patterns Electronic Reports (PEPPER), hosted a webinar on April 30 to present PEPPER updates and to announce the addition of PEPPER for home health agencies.
PEPPER summarizes Medicare claims statistics for one provider in targeted areas that may be at risk for improper Medicare payments.
NAHC has put together a summary of updates, including target areas, for both home health and hospice.
Click here to see it.
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.