Preventable Hospitalizations Down Among American Seniors

According to a new report by the United Health Foundation on the state of seniors’ health, preventable hospitalizations have dropped. The third edition of its annual America’s Health Rankings Senior Report show “encouraging news for senior health nationally,” but also indicates the setbacks seniors have faced compared to previous years.

Among the major gains is a 6.8 percent reduction in preventable hospitalizations, a measure that’s also dropped 11 percent since 2013. Reasons for the reduced hospital admissions and readmissions include the push for better population health management and the shift from fee-for-service model to value-based payments.

The report also found a 9.3 percent increase in the number of home health workers year over year, and a 38 percent increase in seniors who choose hospice care at the end of their lives. These findings are supported by a recent report that indicated nursing homes may replace hospitals as the major providers of senior care – a trend that is fueled by the increased interest in palliative care.

Click here to see the report.

Click here to read more.

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.

Tiptastic Tuesday: CMS Posts CAHPS Hospice Survey Info

CMS has issued two new items on its HOSPICE CAHPS WEBSITE related to the CAHPS Hospice Survey Vendor Authorization and a CAHPS Hospice Survey Fact Sheet.

The following are CMS’ most recent CAHPS announcements:

URGENT: CAHPS Hospice Survey Vendor Authorization Form Due 

The deadline for hospices to complete and submit the CAHPS Hospice Survey Vendor Authorization Form is May 1, 2015. Hospices must authorize an approved CAHPS Hospice Survey vendor to submit data on their behalf for the 2015 administration of the CAHPS Hospice Survey. Please click on Technical Specifications to access the CAHPS Hospice Survey Vendor Authorization Form.

CAHPS Hospice Survey Fact Sheet 

The CAHPS Hospice Survey Fact Sheet located on the CAHPS Home Page contains an overview of the CAHPS Hospice Survey program, information regarding the CAHPS Hospice Survey measures and information for survey vendor participation. 

Click here for additional information on the CAHPS Hospice Survey

Click here to read more from NAHC.

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.

NAHC Outlines CMS’ Revised Medicare Revalidation Policies

CMS has issued change request (CR) 9011 which updates the Medicare Program Integrity Manual on policies related to provider and supplier revalidations. In the manual, sections 15.29.1-15.29.10 are new and include policies that outline the process and timing for revalidations and subsequent deactivations.” CMS will now request that providers and suppliers respond to a revalidation request within 60 days of sending the revalidation letter.

Click here for more detailed information on the revalidation process, including how the new process works.

Click here to view CR 9011.