CMS Open Door Forum: Updates to Home Health Quality Reporting Program & More

On April13, 2021 The Centers for Medicare & Medicaid Services (CMS) held the Home Health, Hospice, and Durable Medical Equipment Open Door Forum. The majority of information shared with the participants pertained to hospice providers. However, several issues impacting home health agencies were also discussed. Home Health Quality Reporting Program (HHQRP) CMS announce that five…

Common Working File Edit Causing Incorrect Payments on Some LUPA Claims

The Centers for Medicare & Medicaid Services (CMS) has issued Change Request (CR) 12085 – Correction to Period Sequence Edits on Home Health Claims. The CR addresses an edit in the Common Working File that bypasses period of care sequencing on Low Utilization Payment Adjustment (LUPA) claims. Before the implementation of the Patient-Driven Groupings Model…

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.…

NAHC to CMS: Roll Back 2020 Rate Adjustment Based on Faulty Prediction of HHA Behavior

The National Association for Home Care & Hospice (NAHC) urged the Centers for Medicare & Medicaid Services (CMS) to roll back the 2020 rate adjustment CMS instituted based on a prediction of how home health agencies (HHA) would behave that has not materialized. That recommendation, and several more, are part of NAHC’s formal comments to…

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…

What the 2020 Medicare Home Health Final Rule Means

The National Association for Home Care & Hospice held a free-to-all webinar on Wednesday, November 5, 2019, to discuss the 2020 Medicare Home Health Final Rule and answer any questions. If you missed the webinar and would like to view the recording, please GO HERE. On October 31, 2019, the Centers for Medicare & Medicaid…

CMS Issues Instructions for PDGM Claims Processing

The Centers for Medicare & Medicaid Services (CMS) has issued Change Request 11081, which provides claim processing  instructions to the Medicare Administrative Contractors ( MACs) that will be necessary to process home health claims with the implementation of the Patient Driven Groupings Model (PDGM). The PDGM will assign 30-day periods of care into one of…