New Innovation Model Tests Flexibility in Home Health and Hospice Benefits

The Centers for Medicare & Medicaid Services (CMS) has announced a new payment and care delivery model being tested by the CMS Innovation Center.  The Geographic Direct Contracting Model (also known as the “Model” or “Geo”) will test whether a geographic-based approach to value-based care can improve quality of care and reduce costs for Medicare beneficiaries…

Study: Medicare Home Health Benefit Not Sufficient to Meet Needs of Post-Acute Beneficiaries

Policy changes could increase value of home health benefit in COVID-19 era Home health care would be very effective providing services to Medicare beneficiaries, but the current design of the home health benefit is insufficient to meet the needs of post-acute beneficiaries, concludes a new study from the Commonwealth Fund. The report’s authors believe policy…

Reporting Requirements for Home Health & Hospice Affected by Hurricane Laura

The Centers for Medicare & Medicaid Services (CMS) is granting exceptions under certain Medicare quality reporting and value-based purchasing programs to home health agencies located in areas affected by Hurricane Laura due to the devastating impact of the storm. The Centers for Medicare & Medicaid Services (CMS) is granting exceptions under certain Medicare quality reporting…

Rise in Patients Discharged to Home Health

The percentage of patients discharged from short-term acute care hospitals (STACH) to home health has risen from 11 percent in May 2019 to 19 percent one calendar year later, according to a new report from ATI Advisory. The number of patients discharged from STACH declined from over 800,000 patients in May 2019 to 558,296 in…

CHAP Shares Standards for the Home Infusion Therapy Supplier

The Medicare home infusion therapy (HIT) supplier benefit is a new Medicare Part B benefit established in the 21st Century Cures Act. The new benefit covers the professional services associated with the provision of Part B infusion drugs, such as, nursing services that are furnished in accordance with a plan of care. The services include…

Recommendations and Clarifications for HHAs on the No-Pay RAP

Beginning January 1, 2021, home health agencies (HHAs) will be required to submit a request for anticipated payment (RAP) that will be paid at 0 percent, prior to each claim. The Centers for Medicare & Medicaid Services (CMS) finalized the No-pay RAP policy in the CY 2020 Home Health Prospective Payment System Rate Update rule.…

Quality Reporting Program Tip Sheets and Training and Education Resources

The Centers for Medicare & Medicaid Services (CMS) has announced that the COVID-19 PR Tip Sheets are now available for the home health quality reporting program (HH QRP) and the hospice quality reporting program (HQRP). The purpose of the tip sheets is to help providers understand the Centers for Medicare & Medicaid Services’ (CMS) public…

Update: Post Payment Medical Review Topics

As previously reported, the Centers for Medicare & Medicaid Services (CMS) authorized the resumption of medical reviews to begin in August. Since the original resumption announcement, hospices and home health agencies have learned that medical reviews administered by the Medicare Administrative Contractors (MACs) will be service-specific post payment reviews. NOTE: Targeted Probe & Educate (TPE)…

Hospice PEPPER Available & Key CMS Updates for Hospice & Home Care in New Open Door Forum

Hospice PEPPER Available The Hospice PEPPER (Program for Evaluating Payment Patterns Electronic Report) is now available. PEPPER is a data report that contains a single hospice’s claims data statistics (obtained from the UB-04 claims submitted to the Medicare Administrative Contractor (MAC)) for areas targeted by CMS as being at risk for improper Medicare payment. Each…

OIG: CMS Could Save Money Reviewing Home Health Claims With Visits Slightly Above LUPA

The Centers for Medicare & Medicaid Services (CMS) could have saved $192 million by targeting home health claims for review with visits slightly above the threshold that triggers a higher Medicare payment, according to a new report from the Office of Inspector General (OIG) of the Department of Health & Human Services. Home health agencies…