PEPPER Updates For Home Health & Hospice

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 To Remove Social Security Numbers From Medicare Beneficiary Cards

CMS has a new mandate to remove Social Security numbers from enrollees’ cards after being warned for more than 10 years by government investigators to remove them. The new requirement is part of a major Medicare payment reform bill signed in law just last week. CMS now has four years to begin issuing new Social Security cards without the numbers, and up to eight years to issue replacement cards to more than 50 million existing enrollees. The conversion is expected to cost $320 million and will be paid from Medicare trust funds. Social Security numbers on the Medicare cards will be replaced by a randomly generated identifier, according to officials.

Click here to read more.

CMS Re-Enabling Registration In IACS System

In January, CMS began a planned one-week transition of the Provider Statistical and Reimbursement Report (PS&R) application from the IACS system to the EIDM system. However, there were technical problems with the transition and it was postponed until further notice. Providers that were not active in the IACS system at the start of the systems transition have not been able to register in the IACS system and are unable to access their PS&R reports, creating difficulties for a number of hospice providers relative to self-calculation and reporting of the 2014 aggregate cap as well as for home health providers that were under the deadline to meet cost reporting requirements.

Effective April 15, 2015, two of CMS’ HHH contractors (CGS and NGS) have announced that CMS is re-enabling registration in the IACS system.

Click here to access the CMS IACS Registration help.

Click here to read more.

CMS Revises Medicare Benefit Policy Manual

CMS has issued Transmittal 205/Change Request (CR) 9114, which makes changes to Chapter 9 of the Medicare Benefit Policy Manual to reflect regulatory changes put into effect as part of the FY 2015 payment rule. CR 9114 revises the manual and provides explicit sections related to the notice of election (NOE), hospice revocation, hospice discharge, and hospice notice of termination or revocation (NOTR), and also expands the existing section on attending physician services. These changes will take effect on May 4, 2015.

From NAHC:

“However, it is important to note that CMS has included a new requirement that — as part of the information identifying the attending physician on the election statement — the hospice must include the physician’s national provider identifier (NPI) number.  This is a change from the information CMS included in the final FY2015 payment regulations in that the NPI was referenced as a potential item for identifying the attending physician on the election statement but not explicitly requiredThe National Association for Home Care & Hospice (NAHC) has concerns that hospices may not have access to the NPI of the attending physician at the time the election statement is signed and that patients may have some concerns about signing a form with empty spaces on it.  One option may be to include space for the attending’s NPI in a FOR OFFICE USE ONLY box on the form.  NAHC has sought guidance from CMS on this issue, and also as to whether it is appropriate for the hospice to enter the attending physician’s NPI on the form after it has been signed.  We will provide any guidance that we receive from CMS in future publications.  In the meantime, hospices and vendors are advised to modify their election statements to include space for the NPI of the patient’s chosen attending physician, as well as to educate staff and modify processes to ensure that the NPI of the attending physician is secured and entered onto the election statement in time for the May 4, 2015, effective date.   NAHC has also sought additional clarification from CMS regarding requirements related to designation of attending physician for purposes of the hospice benefit and is awaiting response.”

Click here for more details from NAHC.

House Passes SGR Reform Bill

Yesterday, a majority passed Medicare legislation that reforms the physician payment formula also known as the Sustainable Growth Rate (SGR). H.R. 2 will now go to the Senate where it is expected to pass.

The bill includes the previously reported provisions that affect home health and hospice services:

  1. The annual payment rate update (Market Basket Index) is set at 1% in 2018. This represents an estimated 1 point reduction from what would otherwise be the update
  2. A two year extension of the home health rural add-on at 3%. Under the bill, the add-on would expire with episodes beginning January 1, 2018 and later.
  3. Modification of the home health surety bond requirements setting the bond minimum at $50,000 and allowing Medicare to scale the bond value up commensurate with the volume of Medicare revenue in the home health agency.

The Medicare beneficiary changes do not include a home health copay.

The bill “would institute a permanent fix in the physician payment methodology” which is good news for Medicare providers as there have been 17 previous “patches” that were financed by cutting provider payment rates.

Click here to read more.

Increased Auditor Scrutiny On F2F Certification Statements

National Government Services has released its schedule of onsite Mobile Medical Review Team visits through September 2014. The one and a half day reviews can result in findings of non-compliance, recoupment and even pre-payment review. Non-compliance with F2F requirements has been a major finding in all audits conducted to date. Be prepared and ready to challenge adverse findings. For more information on correcting invalid or missing F2F documentation, click here.

National Nurses Week 2014

It’s National Nurses Week!  We would like to take the opportunity to thank and recognize the millions of nurses around the country who serve patients every day with compassion and commitment. Nurses dedicate their lives to taking care of the sick and injured by giving them medication, changing them, planning their recovery, and performing a whole array of tests and procedures.

Thank you, nurses, for your dedication, skills, and love that you share with each patient you meet!

“When you’re a nurse, you know that every day you will touch a life or a life will touch yours.”

-Anonymous