Update! Home Health Claims Processing Issues

NAHC became aware of home health claims processing problems in the last several weeks, caused by a Centers for Medicare & Medicaid (CMS) Service systems issue and some Medicare Administrative Contractor (MAC)-specific issues. (See January 12, 2022 NAHC Report for more information.) NAHC quickly began addressing these issues when it was brought to our attention.…

Hospice Mandatory Reporting Reminder: Deadline for Self-reporting of Aggregate Cap is Feb 28

Hospice providers are required to self-calculate and submit their Aggregate Cap Report for the 2021 Cap year no later than February 28, 2022. Failure to file the self-determined cap report with your Medicare Administrative Contractor (MAC) in a timely fashion may result in payment suspension. If you have a Cap-related liability, you are required to submit payment at the time you submit your report.

In order to calculate the Cap, you must be able to access your hospice’s PS&R data, so if you do not have access to CMS’ Identify Management System (formerly EIDM), through which the PS&R data is available) it is advisable that you take action immediately to ensure timely access so that you can meet the reporting deadline.

All three MACs for Home Health and Hospice have online instructions for self-calculation and submission of the Cap report; the information is available at the following locations:

Palmetto GBA

Recent postings to the Palmetto GBA website about the aggregate cap report are  available HERE and HERE.

Palmetto serves Home Health and Hospice providers in Alabama, Arkansas, Florida, Georgia, Illinois, Indiana, Kentucky, Louisiana, Mississippi, New Mexico, North Carolina, Ohio, Oklahoma, South Carolina, Tennessee, and Texas.

CGS

Recent CGS online postings about the aggregate cap report are available HERE.

CGS serves Home Health and Hospice providers in Colorado, Delaware, Iowa, Kansas, Maryland, Missouri, Montana, Nebraska, North Dakota, South Dakota, Pennsylvania, Utah, Virginia, West Virginia, Wyoming, and the District of Columbia.

NGS

NGS has updated its Hospice Cap self-calculation guidance; it is available online on the NGS website HERE.  The form is available in the NGS FORMS section.

NGS has two Home Health and Hospice Jurisdictions (JK and J6) and serves providers in the following states:  Alaska, American Samoa, Arizona, California, Connecticut, Guam, Hawaii, Idaho, Maine, Massachusetts, Michigan, Minnesota, Nevada, New Hampshire, New Jersey, New York, Northern Mariana Islands, Oregon, Puerto Rico, Rhode Island, US Virgin Islands, Vermont, Wisconsin, and Washington.

Hospice Mandatory Reporting Reminder: Deadline for Self-reporting of Aggregate Cap is Feb 28

Hospice providers are required to self-calculate and submit their Aggregate Cap Report for the 2021 Cap year no later than February 28, 2022. Failure to file the self-determined cap report with your Medicare Administrative Contractor (MAC) in a timely fashion may result in payment suspension. If you have a Cap-related liability, you are required to submit payment at the time…

Home Health Claims Processing Issues

NAHC has become aware of some home health claims processing problems last week and this week because of a Centers for Medicare & Medicaid (CMS) systems issue and some Medicare Administrative Contractor (MAC)-specific issues.  NAHC quickly began addressing these issues when it was brought to our attention. The issues are: Notice of Admission (NOA) claims…

MACs to Send Direct Mailing to Hospices Regarding MA VBID Hospice Component Model

In January 2021, the Centers for Medicare & Medicaid Services (CMS) initiated a four-year demonstration model (the MA VBID Hospice Component) under which eligible Medicare Advantage (MA) plans are permitted to offer hospice services as part of the benefit packages. For calendar year (CY) 2022, the MA VBID Hospice Component will expand such that plans…

MACs to Send Direct Mailing to Hospices Regarding MA VBID Hospice Component Model

In January 2021, the Centers for Medicare & Medicaid Services (CMS) initiated a four-year demonstration model (the MA VBID Hospice Component) under which eligible Medicare Advantage (MA) plans are permitted to offer hospice services as part of the benefit packages. For calendar year (CY) 2022, the MA VBID Hospice Component will expand such that plans in 22 states and territories will participate in the model in some areas of each state. In order to ensure that plans appropriately pay hospices serving patients enrolled in a participating plan and that plans are properly paid by CMS for those patients, special billing rules apply to hospices serving patients in the model.

In an effort to raise general awareness of the MA VBID Hospice Component model and to provide education on participation and billing for MA enrollees that receive hospice services in affected areas, CMS recently issued Change Request 12524/Transmittal 11160 – Direct Mailing Notification to Hospice Providers Regarding the Hospice Benefit Component, Value-Based Insurance Design (VBID) Model, Medicare Advantage Organizations (MAOs), directing the Medicare Administrative Contractors (MACs) to conduct a direct mailing to all hospice providers in their jurisdictions affected by the service areas identified for the CY2022 MA VBID Hospice Component.  These service areas are in the following states and territories:

  • Alabama
  • California
  • Colorado
  • Florida
  • Georgia
  • Hawaii
  • Idaho
  • Illinois
  • Indiana
  • Kentucky
  • New Mexico
  • New York
  • Ohio
  • Oklahoma
  • Oregon
  • Pennsylvania
  • Texas
  • Utah
  • Virginia
  • Washington
  • Wisconsin
  • Puerto Rico

According to the transmittal, CMS requires participating MA organizations to communicate with hospice providers in the service area of their participating plans. Hospice providers are also encouraged to communicate with MA plans regarding any questions about the model, billing, coverage, and enrollment. Hospice providers must submit claims and notices to participating MA plans to receive payment when their enrollees elect to receive hospice care. Hospice providers must submit claims and notices to their Medicare contractor, as well, for informational purposes. Enrollees of participating MA plans may seek hospice care with any Medicare-certified hospice provider.

In addition to this specific direct outreach, the MACs have also been directed to conduct education for hospice providers about the CY2022 MA VBID Hospice Benefit Component through relevant outreach events, listserv messages and web postings, which shall include information about CMS and MAC educational products and resources about the model.

Recent NAHC Report coverage of issues related to the MA VBID Hospice Benefit Component Model is available at the following links:

CMS Releases List of MA Plans Offering Hospice under VBID Model in CY2022

CMS Issues Guidance on Determining Hospice Beneficiary Enrollment in MA VBID Hospice Model for CY2022

Home Health & Hospice MAC “Operation Collaboration” Summit Sessions Now Available Online

Earlier this year, the Home Health and Hospice (HHH) Medicare Administrative Contractors (MACs) – National Government Services (NGS), CGS and Palmetto GBA – hosted the 2021 Virtual HHH MAC Collaborative Summit titled, “Operation Collaboration: We are all in this Together”. The Summit was comprised of joint sessions that occurred on September 15 and 17, and…

Hospice MAC “Operation Collaboration” Summit Sessions Now Available Online

In mid-September, the Home Health and Hospice (HHH) Medicare Administrative Contractors (MACs) – National Government Services (NGS), CGS and Palmetto GBA – hosted the 2021 Virtual HHH MAC Collaborative Summit titled, “Operation Collaboration: We are all in this Together”. The Summit was comprised of joint sessions that occurred on September 15 and 17, and MAC-specific sessions that were held on September 16. The three-day event was a huge success, with more than 6,400 HHH provider attendees from every HHH jurisdiction in every state in the US. NGS is now hosting a virtual encore of the Summit video recordings for providers that were unable to attend.

NGS has posted 11 of the sessions online at the following location: HHH Summit Encore – YouTube.  The NGS webinars include joint sessions held on the first and third day of the Summit, as well as the NGS-specific sessions that were conducted on day two. These webinars will be available for viewing through November 25. Please note – two sessions are unavailable due to technical issues with the recordings.

CGS and Palmetto GBA have separately posted the sessions that they held on September 16; these sessions are available at the following locations:

The CGS sessions are available on CGS’ GoToStage at the following location:  https://www.gotostage.com/channel/j15education. This is also accessible from the Recorded Webinars icon on the Education Webpage. To access the CGS-specific Summit sessions go to Home Health and Hospice and look for the sessions identified as Summit sessions.

Palmetto GBA-specific sessions are available at the following location:  https://portal.on24.com/wcc/eh/581986/category/34041/featured (a search using “summit” will pull up the four Palmetto-specific sessions)

CMS to Proceeed with Targeted Probe and Educate

The Centers for Medicare & Medicaid Services (CMS) has decided to continue to proceed with the Targeted Probe and Educate (TPE) medical review, which they resumed on September 1, 2021. (Please see NAHC Report CMS Resumes Targeted Probe & Educate.) Although, the Medicare Administrative Contractors (MACs) have been conducting limited medical review since August 2020, a…

CMS Resumes Targeted Probe & Educate

NAHC urges CMS to suspend TPE until the public health emergency ends The Centers for Medicare & Medicaid Services (CMS) indicated in an August 2021 MLNConnects newsletter that it will resume the targeted probe and educate (TPE) program that was suspended in March 2020 (as were most medical reviews) due to the COVID-19 public health…