Additional Document Requests (ADRs) strike fear into the hearts of most home health and hospice providers. One of the leading reasons for claim denial results from providers not responding to ADRs. That, in itself, will lead to more scrutiny. Providers need to ensure they have a clear cut ADR process including prompt identification of the…
Author: Amy Ross
Hospice Care Index
Believe it or not, the Fiscal Year 2022 for hospice begins in just over a month—on October 1st. Among the changes finalized by CMS is a new item to be publicly reported no sooner than May 2022. The Hospice Care Index (HCI), in effect, replaces the seven HIS items that will be removed from public…
Targeted Probe and Educate Resumes
CMS has announced it is restarting the Targeted Probe and Educate (TPE) program. It has been in suspension since the COVID-19 public health emergency. The program is designed to assist agencies to reduce their claim denials as common claim errors are corrected. The Medicare Administrative Contractors (MACs) use data to identify providers and suppliers who…
Hospice Final Rule
The hospice final rule for Fiscal Year (FY) 2022 was issued on July 29th. This 226 page document–CMS-1745-F–addresses a number of changes including the hospice wage index, payment rates, and aggregate cap amount for FY 2022. Specifically, hospices who submit quality data will receive a 2% raise in payment rates. Hospices who do not submit…
Hospice Expansion
As the elderly population increases along with chronic and age-related diseases, the hospice industry is projected to expand over the next few years. In surveys performed by AARP and others, it’s not surprising to find that most adults have a preference to age in place as long as possible. Earlier this year, MedPAC reported a…
Public Health Emergency
The US Department of Health and Human Services has extended the COVID-19 Public Health Emergency for an additional 90 days effective July 20, 2021. This is the sixth renewal of the PHE since the pandemic was declared in 2020. In particular, the Delta strain of SARS-CoV-2 is now the dominant strain found in the US. …
Home Health Value-Based Purchasing
The Home Health Value-Based Purchasing Model has been in effect since 2016 for nine select states. As expected, the proposed home health final rule for CY 2022 has made plans to expand the model to all 50 states, territories, and District of Columbia next year. This program will be applicable to Medicare-certified home health agencies…
Review Choice Demonstration
The Review Choice Demonstration continues for Medicare home health services in selected states–specifically, Illinois, Ohio, Texas, Florida, and North Carolina. Here’s some of the latest news of RCD: Due to the lingering public health emergency, CMS has extended the phased-in participation for Florida and North Carolina until July 31, 2021. This allows the agencies in…
CMS Emergency Preparedness Testing Clarification
CMS continues to make clarifications to the Emergency Preparedness regulation. A revision to QSO-20-41-ALL was released on June 21, 2021 and was directed to State Surveyors. As previously established, outpatient providers of services, such as home health and home hospice, are required to test their program annually. In 2019, CMS changed the testing requirement for…
New Codes Added to ICD-10 Code Set
The coding addenda for fiscal year 2022 was posted on the CDC website on June 23rd. There are 159 new codes that were finalized and will be added to the ICD-10 code set on October 1st. One code that is included but was absent from the proposed code update is U09.9 (Post COVID-19 condition, unspecified). …
