During its December meeting, the Medicare Payment Advisory Commission (MedPAC) issued draft recommendations advising Congress to reduce Medicare payments to home health agencies by 7% starting in 2026. The recommendations are part of MedPAC’s annual evaluation of payment adequacy across provider settings, which includes assessments of beneficiaries’ access to care, quality, capital availability, and cost-payment…
Author: Amy Ross
CMS Reinforces Hospice Oversight: Focus on Program Integrity and Fraud Prevention
The Centers for Medicare and Medicaid Services (CMS) on November 13, 2024, posted the memo Ref: QSO-25-06-Hospice (Subject: Ensuring Consistency in the Hospice Survey Process to Identify Quality of Care Concerns and Potential Fraud Referrals) which outlines updated guidance to ensure consistency in the hospice survey process. It emphasizes identifying and addressing quality of care…
Comorbidity Adjustments
On November 4th, CMS posted an updated Grouper Tool in order to capture the changes that will be effective on January 1st, 2025, regarding low and high comorbidity adjustments. For fiscal year 2025, there are 22 Low comorbidity adjustments (same number as 2024) and 97 High comorbidity adjustments (down from the 102 in 2024). Low…
Celebrate National Care at Home Month
November 2024 marks a new chapter for the home care community, introducing National Care at Home Month. This celebration unites two powerhouse organizations, the National Association for Home Care & Hospice (NAHC) and the National Hospice and Palliative Care Organization (NHPCO), under the National Alliance for Care at Home. Together, these organizations represent an extensive…
Clarification On Hospice Claims Edit For Certifying Physician
Beginning October 7, 2024, the Centers for Medicare & Medicaid Services (CMS) will implement significant changes to hospice claims processing, as detailed in Change Request (CR) 13531 and the FY2024 Hospice Wage Index and Payment Rate Update final rule. These changes are designed to enhance hospice program integrity and ensure that claims are compliant with…
Hospice Outcomes and Patient Evaluation
On Monday September 16th, 2024 CMS posted the final version of the HOPE (Hospice Outcomes and Patient Evaluation) tool that is effective beginning October 1, 2025. The HOPE tool will take the place of the HIS (Hospice Item Set) but does include many of the same items. Medicare-certified hospices will complete HOPE records for all…
New Home Health Quality Measure
How effective is your agency when it comes to improving functional outcomes for your patients? Beginning calendar year 2025, home health will have a new quality measure that will report how successful agencies are at achieving an expected level of functional ability at discharge. CMS recognizes that home health care has a positive impact on…
Expanded Hospice Oversight
The U.S. Centers for Medicare & Medicaid Services (CMS) will expand its enhanced oversight for new hospices in California, Nevada, Arizona, and Texas to combat fraud, waste, and abuse. This includes prepayment medical reviews of claims before payment by Medicare Administrative Contractors (MACs). Initial review volumes will be low and adjusted based on compliance, but…
Balancing Innovation with Robust Security in Hospice Care
The integration of technology into end-of-life care is revolutionizing hospice services, bringing both significant opportunities and complex challenges. On one hand, advancements such as artificial intelligence (AI), predictive analytics, and telehealth have greatly enhanced care delivery, streamlined operations, and improved both patient outcomes and staff satisfaction. On the other hand, these innovations have introduced new…
FY2025 ICD-10-CM Update
On July 3rd, 2024, the CDC released the FY2025 ICD-10-CM update. The 252 new codes, 36 deletions, and 13 code revisions go into effect on October 1st, 2024. There are a few upcoming changes that are of particular interest: The following new codes will provide additional information regarding the severity of Hypoglycemia when that is…
