Home Health & Hospice Providers: Quality Reporting Resumption and Letters of Noncompliance

NAHC Report wants to remind both hospice and home health providers that quality data reporting  resumed July 1, 2020. For three calendar quarters – October 1, 2019 through June 30, 2020 – the Centers for Medicare & Medicaid Services (CMS) provided an exception for hospice and home health providers from submitting quality data due to…

Program Integrity Manual Updated for Identity Theft and Hospice Aggregate Cap Liability

The Centers for Medicare & Medicaid Services (CMS) recently released a new transmittal that updates the chapter of the Program Integrity Manual to address coordination between Medicare Administrative Contractors (MAC) and Unified Program Integrity Contractors (UPIC) in situations of hospice aggregate cap liabilities, as well as addressing Medicare liabilities in situations of provider identity theft.…

Home Health Reminder and CMS Update to PDGM Split Implementation Instructions

REMINDER: Home Health RAPs Hold Medicare Administrative Contractors (MACs) typically hold claims for a brief period each quarter when they implement system releases. This January, home health Requests for Anticipated Payment (RAPs) are affected by implementation of the Home Health Patient-Driven Groupings Model. MACs will hold RAPs with From Dates on or after January 1,…

Attention Billers: Medicare Secondary Payer Problem With HETS

The Centers for Medicare & Medicaid Services (CMS) and the Medicare Administrative Contractors (MACs) are aware of a problem with the HIPAA Eligibility Transaction System (HETS) Medicare Secondary Payer (MSP) data received from the Common Working File (CWF).  The MACs’ eligibility systems/portals that receive MSP data from HETS may be affected by this issue. Due…

CMS Notifying Agencies of Non-Compliance

Also, you may download preview reports and star rating reports from January 2020 refresh The Centers for Medicare & Medicaid Services is providing notifications to Home Health Agencies that were determined to be out of compliance with Home Health Quality Reporting Program (HH QRP) requirements, which will affect their CY 2020 Annual Payment Update (APU).…

Movement to HETS as Sole Source for Eligibility Queries on Horizon

CWF: 3rd and later hospice benefit periods not calculating correctly In recent years, the Centers for Medicare & Medicaid Services (CMS) has taken steps to transition providers away from direct queries to the Common Working File (CWF) and toward the HIPAA Eligibility Transaction System (HETS) as the single source for beneficiary eligibility transactions.  Earlier this…

CMS to Publish MAC “Cost Report Acceptability Checklists” in Medicare Manual

The Centers for Medicare & Medicaid Services (CMS) has published a transmittal (Transmittal 2273/Change Request 10920) indicating intent to publish (as Exhibits in a forthcoming revised Chapter 8 of the Medicare Financial Management Manual) Cost Report Acceptability Checklists for Hospitals, SNFs, Home Health Agencies/Hospices, and Home Offices that are currently used by the Medicare Administrative…

CMS Updates Providers on PDGM and Quality Reporting Program

The Centers for Medicare & Medicaid Services (CMS) held a Home Health, Hospice & DME Open Door Forum yesterday where CMS representatives provided information on the new Home Health Patient Driven Grouping Model (PDGM), the home health quality reporting program and the Hospice Quality Reporting Program.  A summary of the information shared is below. Home…

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…

Hospices: The Time is NOW to Ensure You are Effectively Managing Your Aggregate Cap Responsibilities

  –NAHC Offers Free Webinar to Members to Advance Industry Expertise The National Association for Home Care & Hospice (NAHC) will hold a critical webinar that every hospice provider needs to attend – Mastering Management and Calculation of the Hospice Aggregate CAP. The webinar will take place on Tuesday, February 5, 2019 from 1:00 PM…