Tag: Medicare Claims Processing Manual

CMS Open Door Forum Shares Hospice Star Rating Info

During the most recent Centers for Medicare & Medicaid Services (CMS) Home Health, Hospice, and DME (Durable Medicare Equipment) Open Door Forum (ODF), the following information and updates were provided.

Hospice providers should note that CMS has resumed the provider enrollment revalidation process along with some other provider enrollment processes that were temporarily suspended during a portion of the COVID-19 Public Health Emergency.  See previous NAHC Report coverage here and the September 2, 2021 MLN Connects newsletter.

UPDATES

Hospices will see the resumption of public reporting of quality data with the February 2022 Care Compare refresh.  Provider preview reports for this refresh can now be accessed via the Certification and Survey Provider Enhanced Reports (CASPER) application. These reports preview data that will be displayed in the Care Compare website in February 2022. The Hospice Item Set (HIS) measure scores are based on fewer than the standard number of quarters due to data exemptions in response to the COVID-19 Public Health Emergency (PHE), and the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey measure scores exclude Quarter 1 and Quarter 2 of calendar year 2020 (but still include eight quarters).

The Provider Preview Reports remain in CASPER for 60 days only so hospices are encouraged to save a copy of their preview reports for later reference.

Learn more about HIS Provider Preview Reports here and about the CAHPS Preview Reports here. Hospice QRP Key Dates for Providers can be found here.

CMS notified hospices that the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey Star Rating will be available to the public on Care Compare in August 2022.  (See previous NAHC Report coverage here). Hospices will first see their star ratings on the preview reports for February this month (November 2021) and also available in the May 2022 provider preview reports. CMS is considering this the “dry run” period.  The star rating will not be publicly reported during this period.

Hospices will see the star rating for each of the eight CAHPS measures in the preview reports but only the summary star will appear on Care Compare.  CAHPS Hospice Survey Provider Preview Reports include both quality measure scores and Star Ratings. Again, CAHPS Hospice Survey Star Ratings will not be publicly reported until August 2022.

CMS shared that it is planning an upcoming HQRP Forum which will include CAHPS information.

  • Thursday, December 16, 2021
  • 2:30 PM – 3:30 PM Eastern

Hospices should mark this on their calendars and stay tuned to NAHC Report for more information. We will provide an update when CMS releases registration information.

Hospices had questions about the CAHPS Star Rating including, in particular, the methodology for calculating the star rating. A CMS slide deck providing an overview of the star rating inclusive of the methodology is available here. Additional information pertaining to the star rating is available here.

Resources for the HQRP and CAHPS Hospice Survey Star Rating are available on the HQRP webpage and the CAHPS Hospice Survey webpage.

In other HQRP news, CMS responded to a question about the timing of the transition to the iQIES system stating that this transition is not scheduled to occur in 2022.

CMS Open Door Forum Shares Hospice Star Rating Info & Updates Home Health Notice of Admission

During the most recent Centers for Medicare & Medicaid Services (CMS) Home Health, Hospice, and DME (Durable Medicare Equipment) Open Door Forum (ODF), the following information and updates were provided. Both home health and hospice providers should note that CMS has resumed the provider enrollment revalidation process along with some other provider enrollment processes that…

CMS Issues Additional Home Health Claim Processing Instructions

The Centers for Medicare & Medicaid Services (CMS) has issued Change Request 12424 that provides additional instructions related claims processing for the notice of admission (NOA) for claims that span calendar years 2021 and 2022, and special circumstances for discharges when no visits are made in a subsequent 30 day period. In the Medicare Claims…

CMS Updates ABN Chapter of the Medicare Claims Processing Manual

The Centers for Medicare & Medicaid Services (CMS) recently revised the Advance Beneficiary Notice of Non-coverage (ABN) section 50 in chapter 30 of Pub. 100-04, Medicare Claims Processing Manual via Transmittal l 10862/Change Request (CR) 12242. The changes are primarily a reorganization of the material, clarifications, and updates.  For instance, some of the examples used…

CMS Issues Manual Instructions for the Home Health NOA

The Centers for Medicare & Medicaid Services (CMS) has issued Change Request (CR) 12256, Replacing Home Health Requests for Anticipated Payment (RAPs) with the Notice of Admission (NOA). The CR updates multiple sections of the Chapter 10 of the Medicare Claims Processing Manual to reflect requirements for the Patient Driven Groupings Model such as adding “Notice of Admission” when applicable and replacing the phrase “60 day…

CMS Corrects Conflicting Policies On Who May Sign Home Health POC, Recertification

The Centers for Medicare & Medicaid Services (CMS) has issued Change Request (CR) 12218, which updates the Medicare Benefit Policy Manual, chapter 7 to correct information on who may sign the certification and recertification for home health patients, and includes instructions for the no -pay request for anticipated payment (RAP). In November 2020, CMS updated chapter…

CMS Updates Hospice Claims Processing Instructions

The Centers for Medicare & Medicaid Services (CMS) recently updated the hospice chapter of the Medicare Claims Processing Manual, changing the billing and processing instructions.  Change Request (CR) 12026 clarifies that in order for the Notice of Termination/Revocation (NOTR) to be accepted into the system, an election period must be established. If the notice of…

CMS Updates Hospice Claims Processing Instructions

The Centers for Medicare & Medicaid Services (CMS) has upted Chapter 11 of the Medicare Claims Processing Manual (Pub 100-04), with the new Transmittal 10173/Change Request (CR) 11807. This CR makes updates to the manual language regarding submitting Notice of Termination/Revocation (NOTR), Processing Professional Claims for Hospice Beneficiaries, and section 30.3 about the Data Required on the…

CMS Issues New G-Codes and Other Claims Processing Instructions

The Centers for Medicare & Medicaid Services (CMS) has issued Change Request (CR) 11721, two new G-codes to indicate on home health (HH) claims when maintenance therapy is provided by a therapy assistant. The CR also provides various clarifying changes to the Medicare Claims Processing Manual, chapter 10, in order to better reflect the policies…

Changes to Requirements for Billing Physician Home Visits

The Centers for Medicare & Medicaid Services (CMS) recently released Transmittal 439/Change Request (CR) 11273, Documentation of Medical Necessity of the Home Visit; and Physician Management Associated with Superficial Radiation Treatment. The new transmittal updates the Medicare Claims Processing Manual, Pub. 100-04, Chapter 12, Section 30.6.14.1 – Home Services to reflect the elimination of the…