Tiptastic Tuesday: 5 Ways To Improve The Palliative-Care Patient Experience

According to new research published in the Journal of Pain and Symptom Management, palliative care providers can significantly reduce their patients’ risk of unnecessary physical and emotional discomfort if they meet 10 quality measures. The research is the result of a two-year project that began with a list of 75 quality indicators which the research team reduced to 10.

Of the 10 recommendations, five include:

  1. Hospice and palliative care patients should receive comprehensive physical, social, spiritual, functional, and psychological assessments soon after admission.
  2. Seriously ill patients should be screened for symptoms, including pain, nausea, and shortness of breath as part of their admission visits.
  3. Patients whose illnesses are advanced or life-threatening and whose screening indicate shortness of breath should develop a plan for managing it.
  4. Seriously ill patients should document their life preferences regarding life-sustaining care.
  5. Providers should give hospice/palliative care patients or their families a relevant survey to assess their care experience.

Click here to read more.

2015 OIG Work Plan Highlights: Hospice Services

Yesterday, we highlighted the home health services section of the 2015 OIG Work Plan. Today, we’ll take a closer look at the hospice services section of the Work Plan:

For beneficiaries living in assisted living facilities, the OIG will review the level of services provided, including the length of stay, level of care received and common terminal illnesses. This information is necessary for CMS to reform the hospice payment system, collect data relevant to revising hospice payments, and develop quality measures. Furthermore, hospice care may be provided to individuals and their families in various settings. These settings include the beneficiary’s place of resident, such as an assisted living facility. Typically, assisted living facility residents have the longest lengths of stay in hospice care, thus requiring more monitoring and examination.

The OIG will also assess the appropriateness of hospices’ general inpatient care claims and the content of election statements for hospice beneficiaries who receive general inpatient care. The OIG will review hospice medical records to address concerns that this level of hospice care is being misused. Beneficiaries may revoke their election of hospice care and return to standard Medicare coverage at any time.

Click here to see the plan.

OMHA Seeks Input On Ways To Reduce Medicare Appeal Backlog

The Office of Medicare Hearings and Appeals (OMHA) has recently published a “Request for Information” regarding the Administrative Law Judge (ALJ) Program for Medicare Claim Appeals. The Request follows a OMHA Appellant Forum where OMHA officials “detailed the ever-increasing appeal backlog along with its initiatives to bring greater efficiencies and productivities into the ALJ appeal process.”

There are nearly 900,000 ALJ level appeals awaiting assignment and processing. Due to the volume of pending appeals, the assignment of appeals to ALJs has been suspended since July 2013. OMHA has has taken steps to improve the appeals process since the backlogged appeals began. NAHC has recommended that CMS “institute a mass settlement option that offers the home health and hospice community a quick and simple process for a compromise settlement based on historical ALJ reversal rates.”

Click here to access the Request for Information.

Click here to read more from NAHC.

OIG 2015 Work Plan Released

The Office of the Inspector General (OIG) has just released its 2015 Work Plan and it looks a lot like its 2014 plan. The OIG will still be focused on inappropriate Part A and Part B billing in Nursing Facilities; general inpatient care billing for Hospice; compliance with PPS requirements in home health, with special scrutiny on newly enrolled home health agencies as well as review of employment of individuals with criminal convictions in the home care setting. The OIG will also still be looking at inappropriate Part B billing for Chiropractor services; place of service coding errors for Physician services; and the high use of outpatient Physical Therapy services.

To read the OIG’s full plan, click here.

New Medicare Guidance For Hospice Patients

New Medicare guidance aiming to stop the federal government from paying millions of dollars to hospice organizations and drug companies for the same prescriptions for seniors takes effect today. Experts say the changes could make it make it more difficult for hospice patients to get certain medications.

The new measure allows insurers to deny coverage for any prescriptions for hospice patients until they know that the drugs are not covered instead by the hospice provider. Medicare officials say the aim of the additional authorization is to “prevent duplicate payments for drugs covered under hospice benefit.”

Click here to read more.

VA Delays Effective Date to Implement Payment Methodologies for Home Health & Hospice Providers

The Department of Veterans Affairs (VA) has issued a rule that delays the effective date for the billing methodology for non-VA providers of home health services and hospice care. In the May 6, 2013 Federal Register, the VA published a final rule which established a November 15, 2013 effective date to change the billing methodology for non-VA providers of home health services and hospice care that have not negotiated a rate with the VA. This announcement delays that effective date to April 1, 2014.

On February 18, 2010, the VA issued a proposed rule to implement certain payment methodologies for all non-VA inpatient and outpatient health care professionals and providers, which included paying according to Medicare fee schedules and prospective payment systems, as applicable. When the final rule was published on December 17, 2010, however, the regulation included an exception for implementing the payment methodologies for home health and hospice services.

The VA cited administrative and systems problems that prevented their ability to implement the Medicare payment system for home health and hospice services on such short notice.

Additionally, on May 6, 2013, the VA published a final rule that established an effective date of November 15, 2013 for the payment methodology for non-VA home health and hospice providers that do not have a negotiated contract with the VA.

Services provided by non-contracted home health and hospice agencies were to be paid the lowest of the following amounts:

  • The applicable Medicare fee schedule or prospective payment system amount (“Medicare rate”) for the period in which the service was provided;
  • The amount negotiated by a repricing agent if the provider is participating within the repricing agent’s network and VA has a contract with that repricing agent. For the purposes of this section, repricing agent means a contractor that seeks to connect VA with discounted rates from non-VA providers as a result of existing contracts that the non-VA provider may have within the commercial health care industry;
  • The amount that the provider bills the general public for the same service.

The VA has delayed the November 15, 2013 implementation date until April 1, 2014 due to unforeseen difficulties in contracting and information technology procedures required to apply the billing methodology to non-VA home health services and hospice care.

CMS Issues Change Request Regarding Demand Billing of Hospice GIP

The Centers for Medicare & Medicaid Services (CMS) issued Change Request (CR) 8371 regarding Demand Billing of Hospice General Inpatient (GIP) Level of Care effective January 1, 2014, with an implementation date of January 6, 2014.  CR 8371 instructs hospices on preparing demand bills when GIP is denied and the routine home care rate is applicable. Billing instructions for demand bills associated with Advanced Beneficiary Notice of Non-coverage (ABN) issuance are contained in Chapter 1 (General Billing Requirements) of the Claims Processing Manual in section 60.4.1 Outpatient Billing with an ABN (Occurrence Code 32).

Click here to read more

Conversation Enders Guide

Canadian researchers have crafted a conversation guide to help clinicians effectively communicate with patients nearing end-of-life and their family members.  The conversation guide includes suggestions how to phrase questions to elicit answers as well as a step-by-step guide to explain patients’ prognosis and how to respond appropriately to patients’ reactions.

Click here to read more

New CoP Requirment For LTC Facilities Right Around The Corner

The Centers for Medicare & Medicaid Services (CMS) has added a new Condition of Participation (CoP) requiring LTC facilities that arrange hospice services through a Medicare-certified hospice to establish a preliminary agreement in writing that specifies the roles and responsibilities that each will contribute to the hospice services.  The purpose of the new CoP, effective August 26, is to protect residents from conflicting services as part of the hospice benefit and to improve communications between providers to ensure that no hospice services will be overlooked.  For clients, entering or transferring into a hospice facility will require a formalized contract with at least one provider agency.

Click here to read more

CMS Home Health Open Door Forum Next Week

The Centers for Medicare & Medicaid Services (CMS) is hosting its next Home Health, Hospice & Durable Medical Equipment (DME) Open Door Forum Wednesday, June 26, 2013 from 2:00p.m.-3:00p.m., ET. To participate, dial 1-800-837-1935 and reference Conference ID# 97842778.

Click here for more information.