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…
Tag: home health
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…
Home Health Proposed Rule Seeking Comment on Assessments by Therapists (PT, SLP, OT)
CMS seeks public comments regarding whether CMS should shift its longstanding policy and permit all classes of rehabilitative therapists (PTs, SLPs, and OTs) to conduct the initial assessment and comprehensive assessment for cases that have both therapy and nursing services ordered as part of the plan of care. They are asking the public for data,…
State Operations Manual (SOM) Appendix B Revisions
On March 15, 2024, CMS released Memorandum QSO-24-07-HHA. The memorandum summarizes changes made to State Operations Manual (SOM) Appendix B – Guidance for Surveyors: Home Health Agencies based on final rules which have amended home health conditions of participation. Key changes include:
Medical Necessity
One of the most common reasons for home health claims denials revolve around medical necessity for skilled nursing services—denial code 5HN18. During the first quarter of 2021, the Medicare Administrative Contractors identified this denial reason among the top five. The solution boils down to a good understanding of skilled nursing services and documentation, documentation, documentation. …
Additional Document Requests
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…
Home Health RCD Top 5 Non-Affirmation and Claim Denial Reasons
Review Choice Demonstration (RCD) did not add any new requirements, but home health agencies are still struggling with the Face-to-Face (F2F) and getting an affirmation. Agencies need to remember that the F2F documentation must be “related” to the primary diagnosis (the primary reason for home care) and must be timely. This means that the encounter…
