Reviewing HHVBP Updates in the Recently Released Interim and Annual Performance Reports

The July release of the Interim Performance Reports (IPR) were released at the end of July, and the reports include the first quarter of 2025 OASIS Outcome Measures, along with the remaining measures through December 31, 2024.

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Understanding the New Medicare Spending Per Beneficiary Measure in the 2026 Home Health Proposed Rule

One of the most significant additions is a new measure called the “Medicare Spending Per Beneficiary Post-Acute Care Measure”. To help explain this change, Jennifer Osburn, one of our consultants here at Healthcare Provider Solutions, will walk us through the key components of how the Medicare Spending Per Beneficiary calculation is determined.

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2026 Home Health Proposed Rule Released

On June 30, 2025, CMS released the 2026 Home Health Proposed Rule, and with this proposal comes the introduction of a number of unexpected and significant changes that could have far-reaching impacts across the industry.

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Understanding a Notice of Medicare Non-Coverage Update that Agencies Overlooked

An important topic needs to be addressed that seems to have been overlooked by some agencies related to the recent update to the Notice of Medicare Non-Coverage, which took effect on January 1, 2025. We previously shared a Monday Minute discussing the new requirement that Medicare Advantage patients must now receive the same Notice of Medicare Non-Coverage form as traditional Medicare patients. This includes the BFCC-QIO information.

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Four New OASIS Items for 2027 – Health-Related Social Needs

Today, we’re going to explore the possibility of four new items possibly being incorporated into your current comprehensive assessment—well before they are set to officially become part of the OASIS document in 2027. This would allow us to start identifying the key areas to highlight once they take effect.

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Understanding the Difference between Conditions of Participation and Conditions of Payment

The difference between the Conditions and Participation and the Conditions of Payment is a crucial topic, and a critical issue regarding the distinction between the two needs to be addressed. When discussing the Conditions of Participation, it’s well understood that compliance with CoPs is essential. Whether in home health or hospice, surveyors carefully review these conditions during their surveys.

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Clarifying Uncertainty Surrounding the Timely Initiation of Care Outcome Measure

A long-established outcome measure for home health, the Timely Initiation of Care Outcome Measure, seems to have some uncertainty surrounding it that we’d like to clear up. The Timely Initiation of Care Outcome Measure is determined using the dates recorded in the OASIS document.

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Understanding the Increased Focus on Teaching Episodes and What Medical Reviewers are Looking for in the Documentation

Recently, audits like Targeted Probe and Educate (TPE), UPIC, SMRC, and RAC have become more frequent, especially since the start of the year. A notable area of focus for home health agencies that wasn’t heavily scrutinized in the past is teaching episodes.

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Reviewing Recent Home Health Value-Based Purchasing Updates

The October Interim Performance Reports (IPR) were delayed and were eventually published in December 2024. If you have not yet reviewed the most recent IPR reports, they are now available in your iQIES system.

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2024 Home Health Year in Review and Looking Forward to 2025

As we close out 2024, Home Health has been a rocky road at best. We expect that this will continue into 2025, but with advocacy efforts comes the potential for improvement.

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New Regulation Requiring Notice of Medicare Non-Coverage to Include BFCC-QIO Information

A new regulation has been released regarding Medicare Advantage plans. If you are providing home health services to a patient enrolled in a Medicare Advantage plan, you are now required to issue the Notice of Medicare Non-Coverage. This notice must include information about the BFCC-QIO, allowing patients the opportunity to appeal decisions related to their discharge.

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Understanding the Most Recent Home Health Value Based Purchasing Model (HHVBP) Reports

The October 2024 Interim Performance Reports provide data for the previous 12 months, ending in June 2024 for OASIS data and March 2024 for HHCAHPS and claims data. It is crucial to regularly monitor your reports and address any significant discrepancies between your expected scores and those shown in the interim reports.

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CMS Releases 2025 Home Health Final Rule & Quality Update

The much-anticipated 2025 Home Health Final Rule was posted Friday, November 1, 2024, and includes applicable changes for implementation in calendar year (CY) 2025 and beyond.

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Understanding the Impact OASIS Section GG Changes will have on Home Health Agencies

The GG section of the OASIS is about to have a huge impact on all home health agencies through the Home Health Value-Based Purchasing Model. The GG items on the OASIS document have been included for several years and were originally taken from the SNF Assessment.

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Interim Performance Reports (IPR) July 2024 Update Released

Last week, the July update to the Interim Performance Reports (IPR) was released, marking the first time, data from all of 2023 has been included in the reports. The data covers all 12 months for every measure in Value-Based Purchasing.

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2025 Home Health Proposed Rule Clarifies Mandatory OASIS Requirements

On June 26, CMS released the 2025 Home Health Proposed Rule. Among the changes in this proposed rule include updates to OASIS requirements that will become mandatory in 2025.

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BFCC-QIO Changes that could Impact Medical Review

The BFCC-QIO, an organization that patients and caregivers can turn to for filing complaints or expressing concerns about the care or information they’ve received from a provider, is set to undergo changes.

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CMS Releases OASIS E1 Draft Version Ahead of 2025 Changes to Quality Reporting and Value Based Purchasing Programs

On January 2, 2024, The Centers for Medicare and Medicaid Services (CMS) released a new, draft version of OASIS E1, which is to be used beginning January 1, 2025. The updated version of OASIS E is a result of a 2023 review of the data set by CMS with intention to identify items that did not meet criteria for inclusion.

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April Home Health Value Based Purchasing IPR Reports Released

At the end of April, the latest release of the Home Health Value Based Purchasing Interim Performance Reports (IPR) was released. This edition includes data calculations for the OASIS items through December 2023, providing a full year’s worth of data for 2023.

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Review Choice Demonstration Extended for Five More Years

The Review Choice Demonstration, a program that offers home health agencies several options for claim reviews, has been extended for another five years. This demonstration, managed by the Medicare Administrative Contractor Palmetto GBA, is currently in effect in five states.

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Important Updates and Clarifications for Home Health Claim Processing

At the beginning of April, CMS issued key updates and clarifications regarding home health claim processing. The changes were issued through Change Request 13543. This Change Request transmittal brought a number of clarifications to the claims processing manual.

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Jennifer Osburn Joins Healthcare Provider Solutions Team as Clinical Consultant

Healthcare Provider Solutions (HPS), a leader in providing billing, coding, and clinical services to the home health and hospice industries for over 22 years has welcomed Jennifer Osburn to their team as a Clinical Consultant. Jennifer will be focusing on OASIS E & Coding education to home health agencies across the nation.  In addition she will be available to agencies for operations and clinical case management consulting. 

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January 2024 IPR Reports Released

The January 2024 IPR Reports have been published, updating the home health Value-Based Purchasing Model scores for agencies, using 2023 data. The reports, which were published in the first week of February, also provide updates to the July and October reports.

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Regina Wild Joins Healthcare Provider Solutions as Director of Managed Care Consulting

Regina Wild, LPN, has joined Healthcare Provider Solutions (HPS) as their Director of Managed Care Consulting. In her role at HPS, Regina specializes in assisting clients with obtaining managed care contracts, conducting rate negotiations, credentialing with health plans, and renegotiating current contracts.

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Recent Edit is Blocking Home Health and Hospice Claims from Being Paid

A recent edit is blocking home health and hospice claims from being paid at Palmetto GBA, and possibly at NGS and CGS as well. The edit, which begins with the number “5” and the letter “Z”, is not only stopping payment but is also changing the bill type to a 320 for home health.

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Clarifying Common Misconceptions of Patient Driven Groupings Model (PDGM) HIPPS Code Calculations

Common misconceptions regarding the calculation of the Patient Driven Groupings Model (PDGM) HIPPS codes exist and need clarification.

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Recent Updates to the Home Health Value-Based Purchasing Expansion

As a result of updates to the Home Health Value-Based Purchasing Expansion, CMS has introduced a new email address, released a comprehensive resource document, and released a document providing a summary of a conversation had by the Technical Expert Panel.

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Home Health Value-Based Purchasing Model Changes Effective 2025

The Home Health Final Rule for 2024 that was published at the beginning of November contained many changes – including ones that will specifically impact the Home Health Value-Based Purchasing Model in 2025.

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2024 Home Health Final Rule Released

The Home Health Final Rule for 2024 was published on November 1, 2023, and with it comes many changes. The outlined changes in the 531-page document will go into effect starting on January 1, 2024.

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October IPR Reports Released for HHVBP

In today’s Monday Minute, Melinda discusses the insight that can be taken from the October 2023 IPR reports.

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Payment Reduction when the Home Health Quality Reporting Requirements are Not Met

In this Monday Minute, we discuss the mandatory compliance of the Home Health Quality Reporting program.

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Preview Reports Released for the January 2024 Home Health Quality Reporting Program Care Compare Refresh

In this week’s Monday Minute, we discuss the recent release of preview reports for the Home Health Quality Reporting Program, which will be used for the Care Compare data refresh in January 2024.

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OIG Report Focuses on the Lack of Accurate OASIS Documentation of Falls with Major Injury

In this Monday Minute, we discuss the latest OIG report which focuses on the accurate OASIS documentation of fall related injuries.

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Reviewing Proposed Changes to the Home Health Value-Based Purchasing Model for 2025

In this week’s Monday Minute, we discuss the proposed changes specific to the Home Health Value-Based Purchasing model that will go into effect in 2025.

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Reviewing the July 2023 Home Health PEPPER Report

In today’s Monday Minute, we discuss the Home Health PEPPER report released July 2023.

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Reviewing the First IPRs in the Recent Value-Based Purchasing Model Update

In today’s Monday Minute, we discuss the nationwide expansion of Value-Based Purchasing in 2023 and the release of the first IPR reports for review.

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Reviewing the 2024 Home Health Proposed Rule

In this weeks Monday Minute, we discuss the 2024 Home Health Proposed Rule.

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Reviewing the July IPR Release for the 2023 Home Health Value-Based Purchasing Expansion (VIDEO)

In this week’s Monday Minute, we discuss the IPR (Interim Performance Reports) that will be released in July for the Home Health Value-Based Purchasing Expansion for 2023.

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Clarifying Occupational Therapy’s Role in Start-of-Care Assessments and Home Health Admission (VIDEO)

In this Monday Minute, we discuss the clarification surrounding Occupational Therapists being allowed to conduct a Start-of-Care comprehensive assessment.

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Face-to-Face Documentation Requirement for Home Health

Learn the requirements for a valid Face-to-Face encounter documentation under the home health primary diagnosis. Reviews the changes to telehealth options made during the Public Health Emergency as well as guidelines from Medicare MAC regarding what needs to be included in documentation for it to meet medical review standards.

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Telehealth Clarification at the End of the Public Health Emergency for Home Health and Hospice (VIDEO)

In this Monday Minute, we discuss the official end of the Public Health Emergency on May 11, 2023, causing many of the 1135 waivers to be discontinued on the same day.

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Improving Home Health Therapy Documentation – Let’s Get Moving!

Get an overview of therapy services in home health, including the importance of Home Health therapy documentation for compliance, quality of care, patient satisfaction, care coordination, and reimbursement.

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Waivers Ending for Home Health Agencies as the Public Health Emergency is Terminated (VIDEO)

In this week’s Monday Minute, we will talk about the waivers ending for home health agencies as the Public Health Emergency ends.

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Discussing the January 2023 Quarterly OASIS-E Q&A (VIDEO)

In this week’s Monday Minute, we discuss questions that were asked in the quarterly OASIS-E Q&A released on January 17, 2023.

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CMS Updates to the OASIS-E Guidance Manual (VIDEO)

In this week’s Monday Minute, we discuss the update to the OASIS-E Guidance Manual that was released by CMS in December 2022.

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Updated G-Codes Relating to Telehealth and Billing Non-Routine Supplies in Home Health (VIDEO)

This Monday Minute discusses Telehealth G-codes effective January 1, 2023 and billing Non-Routine Supplies.

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Coding Changes for Home Health Related to the PDGM Model (VIDEO)

In this Monday Minute, we will discuss specific coding changes related to the PDGM model for Home Health.

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Reviewing Home Health Value-Based Purchasing Pre-Implementation (VIDEO)

In this week’s Monday Minute, we will review the Home Health Final Rule regarding Value-Based Purchasing that is set to begin in January 2023.

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Reviewing the 2023 Home Health Final Rule (VIDEO)

In this Monday Minute, we review the 2023 Home Health Final Rule that was released on October 31, 2022.

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Implementation of OASIS-E and High Level Changes to the Data Set (VIDEO)

This Monday Minute reviews highlights of the instruction for completion of some of the new items in OASIS-E and other changes to the Data Set.

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Hospice New Rates 2023, ICD-10 Codes Updated & PDGM Proposed (VIDEO)

In this Monday Minute, we discuss the many changes that have gone into effect beginning on October 1, 2022 for Hospice and Home Health.

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Medical Review and Plan for the Next Visit Documentation (VIDEO)

This Monday Minute discusses the requirements of documenting the true plan for the next visit on individual visit notes and what consequences will be paid under Medical Review when not accurately documented.

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How QAPI Processes Can Support Improvement in Home Health Value-Based Purchasing (VIDEO)

In this Minute, we will discuss the updated fact sheet related to the Public Health Emergency for the status of waivers for both home health and hospice individually.

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Clarifying Requirements for Coding and the Face-to-Face Encounter (VIDEO)

In this Monday Minute, we will discuss a question that frequently comes up when discussing coding and the Face-to-Face encounter, especially under Medical Review.

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Targeted Probe and Educate 101: What You Need to Know (VIDEO)

Targeted Probe and Educate is a major issue that makes Home Health and Hospice agencies anxious. This video covers the process of Targeted Probe and Educate, what happens when you fail a review, and how to prevent it.

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Home Health Value-Based Purchasing Program Nationwide Expansion

The expanded Home Health Value-Based Purchasing Model will use benchmarks, achievement thresholds, and improvement thresholds, based on baseline year data, to calculate achievement and improvement of Home Health Agency performance on quality measures.

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Review Choice Demonstration Cycle Selection Update (VIDEO)

This Minute reviews the current cycles and upcoming selection dates in some states.

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OASIS-E Implementation is Imminent! (VIDEO)

This Minute will provide a high-level overview of the release of the OASIS E Guidance Manual and the significance of starting education NOW!

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Diagnosis Coding Update for April 1, 2022 (VIDEO)

This Monday Minute will briefly review the new ICD-10 Diagnoses related to COVID Vaccinations.

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Value Based Purchasing – Impact of OASIS Items (VIDEO)

This Monday Minute will take you through some of the key components of OASIS and the impact they have on the Value Based Purchasing outcome measures.

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Home Health Value Based Purchasing – Rollout 2023 (VIDEO)

This Monday Minute will touch on the highlights of the nationwide implementation of Home Health Value Based Purchasing, effective 1/1/2023.

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Home Health & Hospice Quality Reporting Programs (VIDEO)

This Monday Minute will review the reality that the Home Health and Hospice Quality Reporting Program requirements were reinstated with penalties as of July 1, 2020. We will review the deadlines, what is included in those, and the penalties that will be assessed if you are not compliant.

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NEW GG Item Education for OASIS Completion (VIDEO)

This Monday Minute assists in making agencies aware of the new GG Item Education that CMS has published on their website for OASIS completion. We have provided a link to this new education and hopefully, you’ll find it very useful in the training of your staff specific to the GG Items in the OASIS documentation.

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Local Coverage Determinations (LCD) (VIDEO)

This Monday Minute reminds home health and hospice about the significance that the LCD can have in the medical review of Medicare charts. We want to remind you about a very important document that the Medicare MACs have developed to help assist agencies in understanding the expectation of your medical record documentation.

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Case-Mix Weight Changes in the HH Proposed Rule 2022 (VIDEO)

This Monday Minute provides thoughts about the potential impact of the proposed case-mix weight changes on overall reimbursement in 2022.

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Home Health Care and Home Infusion Therapy Benefit

This article will detail eligibility requirements for Medicare home health patients—homebound, face-to-face, skilled need—and will discuss the new payment model, the Patient-Driven Groupings Model (PDGM). The article also includes case scenarios for home health patients that require IV therapy as well as other home health interventions for various disease processes and the Medicare Home Health Benefit and the HIT Benefit intertwine.

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Value Based Purchasing Nationwide Rollout 2022 (VIDEO)

This Minute briefly reviews some of the highlights of Value Based Purchasing and what has been proposed. Value-Based purchasing has been proposed in the form of a nationwide rollout for home health beginning in January 2022.

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Targeted Probe & Educate: Here We Go Again! (VIDEO)

This Minute will take you through a quick recap of the Targeted Probe & Educate framework as the program is being reinstated!

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Proposed CoP Changes that Need Your Feedback (VIDEO)

This Minute reviews the four items that are being proposed for change in the Home Health Conditions of Participation, specific to home health aide supervision. Make sure to stay tuned for more updates!

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Review Choice Demonstration Update (VIDEO)

This minute covers the update for Florida and North Carolina Home Health Review Choice Demonstration (RCD). Palmetto GBA provides HHAs with a wealth of information addressing the requirements and expectations of the RCD. Make sure to stay tuned!

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Home Health Value-Based Purchasing Annual Report (VIDEO)

This Minute covers a review of the Home Health Value-Based Purchasing (HHVBP) Model – Fourth Annual Report. Make sure to stay tuned!

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Emergency Preparedness UPDATE Blog

The Center for Clinical Standards and Quality/Quality, Safety & Oversight Group updated guidance for surveyors in QSO-21-15-ALL which revised emergency preparedness considering the Public Health Emergency (PHE). Emergency Preparedness (EP) takes a front seat with the Pandemic – CMS has revised the EP condition to add elements related to the Public Health Emergency (PHE) and the Pandemic.

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COVID-19 Coding Changes

It remains challenging to code COVID-19 for patients, as there are so many variations seen, especially as time goes on.   However, as of January 1, 2021, we have new diagnosis codes that are to be used for COVID-19 patients. They don’t include all of the patient scenarios for the conditions seen after COVID but it is a start.

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COVID-19 Vaccine Administration (VIDEO)

Welcome to Monday Minute with Melinda! This week’s video clip will discuss the billing and reimbursement for COVID-19 Vaccine Administration. Make sure to stay tuned!

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OIG Conducting Audit on Telehealth (VIDEO)

Welcome to Monday Minute with Melinda! This video clip will recap some of the documentation requirements for telehealth and the OIG audit to take place. Make sure to stay tuned!

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Exceptions for Late RAPs! (VIDEO)

Welcome to Monday Minute with Melinda! This week’s video offers quick tips on ensuring that you are coding appropriately for requesting an exception to a late RAP in 2021. Monday Minute with Melinda gives agencies the opportunity to receive critical weekly video updates, Make sure to stay tuned!

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Home Health Final Claim Clarification (VIDEO)

Monday Minute with Melinda gives agencies the opportunity to receive critical weekly video updates. This week, Melinda highlights the most recent clarification for Medicare Home Health Billing of Final Claims in 2021. Help with cleaning out your Return to Provider Claims is just a click away!

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COVID-19: Interim Final Rule & What It Means for Home Health

There have been two Interim Final Rules, the most recent on May 1, that have been issued by CMS during this historic pandemic of the century. This Public Health Emergency (PHE) has taken the full focus of national officials and in the process, there have been sweeping concessions for healthcare, some permanent and others temporary.

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COVID-19: Imperative Home Health and Hospice Updates

This article was last updated on May 7, 2020.

As we are facing the pandemic of the century, home health and hospices are on the frontline of this Public Health Emergency (PHE) along with hospitals, physicians and all other healthcare workers. We at Healthcare Provider Solutions, Inc. would like to take this moment to thank each and every one of you for your true dedication to treating patients and helping the world to be a healthier place. HPS is dedicated to providing the Home Health and Hospice industries with the education and resources necessary to keep you performing at the highest level of success.

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PDGM Series: The 2020 Proposed Rule Update

January 1, 2020 will bring many new beginnings, including the Patient Driven Groupings Model (PDGM). No doubt the largest reimbursement system overhaul in home health since October 2000.
CMS continues to tweak the model and updates to the Claims Processing Manuals have begun.

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OASIS-D1 Update & PDGM Impact

CMS has announced that the revised OASIS-D1 instruments will be effective January 1, 2020. Changes to the OASIS-D data set and data collection guidance were finalized in the Calendar Year (CY) 2019 HH Final Rule, CMS 1689-FC.

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Review Choice Demonstration Implementation Plan

The choice selection period for HHAs located in Illinois will begin on April 17, 2019 and end on May 16, 2019. Agencies in the other four targeted states; Ohio, North Carolina, Texas and Florida, should begin immediate preparation for RCD as it is imminent in your state!

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7 Best Practices and Tips for OASIS-D Compliance and Home Health Quality Assurance

Home health agencies may find many of the changes to OASIS-D daunting, but there are several modifications that have helped make assessments easier than ever before. The Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act) is the primary driving force behind the OASIS changes.

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The Review Choice Demonstration (RCD) Is Here!

The Office of Management & Budget (OMB) officially approved implementation of the Review Choice Demonstration in Home Health. Review Choice Demonstration (RCD) for Home Health Services will give providers in the demonstration states an initial choice of three options…

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OASIS-D: ARE YOU READY FOR 2019?

OASIS has indeed changed again and quite dramatically this time. While there are 28 M items that have been deleted from the data set and only 6 new ones added, don’t be fooled into believing that this will be a breeze.

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2019 Home Health Proposed Payment Rule – PDGM 2020

The Centers for Medicare and Medicaid Service (CMS) released the CY2019 Medicare Home Health payment rule July 12, 2018. This proposed rule is voluminous and carries an immense number of proposed changes. HPS will continue analyzing and updating the proposed elements of this rule.

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Diagnosis Coding for Home Care – Tips for Success

As the first year of PDGM has unfolded there have been many twists and turns in the new complexity of coding in home care. Many of the diagnosis codes we had been utilizing in home health, are no longer allowed as a primary diagnosis, called unacceptable primary diagnoses. Coding has always been important in home care, but is increasingly being scrutinized. Stay ahead of the game and ensure that your coding is up to par.

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Pre-Claim Review Demonstration Coming Back?

CMS released a Comment Request, via the Federal Register, regarding Pre-Claim Review Demonstration being set to return on or after October 2018 in Illinois, Ohio, North Carolina, Florida, and Texas. The revised demonstration would last five years and Illinois will kick off the demonstration again and will be followed by Ohio and North Carolina and later Texas and Florida.

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OASIS D – What is on the Horizon?

OASIS D data set has been released as proposed and will be in the form of a final rule soon. There has not yet been a release of actual guidance in completing new items added to the OASIS D data set, but the items being removed and added has been proposed. We are providing information about the items removed and the new items added to the OASIS data set for 01/01/2019 implementation.

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Targeted Probe and Educate – What We Have Learned So Far

Targeted Probe & Educate began on 10/1/17 and is full speed ahead. HPS has discovered nuances with TPE that we did not expect nor have we experienced in past ADR reviews. This review includes targeted medical review and education along with the potential of elevated action toward the agency. This elevated action could take place if the agency is not meeting the standards laid out by the Medicare MAC.

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2018 Home Health Final Rule

The Breaking News that has every one full of excitement and hope is that the 2018 Home Health Final Rule does NOT include finalizing HHGM, at this time, which was set for implementation in 2019! The battle has been won, BUT the war has just begun! Some form of payment reform will occur in home health. It is not…

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Claim Denials Due to NO OASIS Will Now Return to Provider

The claim edit that has been in place since April 3, 2017 has been denying home health claims, at the point of billing, if the matching OASIS was not in the ASAP database. Some of these denials have been the result of data not matching between the claim and the OASIS, primarily the patient’s HIC number being different or the OASIS…

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Targeted Probe and Educate

HPS reported recently regarding continued Probe & Educate for Home Health agencies. This is to clarify that the CMS expansion on Probe & Educate is for Home Health and Hospice and will be effective 10/1/2017. This is referred to as Targeted Probe & Educate (TPE). This review will include targeted medical review and education along with an option for potential elevated action, up to and including referral to other Medicare contractors including the Zone Program Integrity Contractor (ZPIC), Unified Program Integrity Contractor (UPIC), Recovery Audit Contractor (RAC), etc.

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2018 OASIS-C2 Guidance Manual Update

CMS issued a statement and an update to the OASIS-C2 Guidance Manual regarding the One Clinician Convention. CMS states: “As required by the Conditions of Participation, the Comprehensive Assessment will continue to be the responsibility of one clinician. However, effective January 1, 2018, the assessing clinician will be allowed to elicit feedback from other agency staff, in order to complete any or all OASIS items integrated within the Comprehensive Assessment.” One key element that agencies should…

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2018 Home Health Proposed Rule – HH QRP

The 2018 Home Health Proposed Rule was released 07/28/17. The 2018 Home Health Proposed Payment Rule – Including Intro to HHGM regarding this rule primarily discussed the proposed reimbursement changes for 2018 as well as the massive changes to the Prospective Payment System in the form of HHGM. The following is a recap of the proposed changes to the Home Health Quality Reporting Program (HH QRP).

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2018 Home Health Proposed Payment Rule – Including Intro to HHGM

The Centers for Medicare and Medicaid Service (CMS) released the CY2018 Medicare Home Health payment rule last week. This proposed rule is voluminous and carries an immense number of proposed changes.  HPS will continue analyzing and updating on the proposed elements of this rule.

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Delayed Implementation of Home Health CoPs

Last week CMS issued a Final Rule that changed the new Home Health CoPs rule implementation date to January 13, 2018. HPS announced the proposed rule a few months ago. NAHC and the Forum of State Associations spearheaded this effort to postpone the rule because of the extensive changes that are…

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Home Health COPs Delayed

CMS just issued a proposed rule that will change the new Home Health CoP rule effective date to January 13, 2018. NAHC and the Forum of State Associations spearheaded an effort to postpone the rule because of the extensive changes that are required and the absence of needed interpretive guidance to properly comply.

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HIPAA for Home Care | Establishing A Compliant Agency

HIPAA has become an acronym synonymous with healthcare. We see it practiced and preached daily throughout the home care and hospice industry. However, too often breach notifications are at the top of our industry headlines. These breaches are costing our agencies time, money, and patient credibility. If we as agency owners, administrators, and employees understand the severity of a breach then why are breaches still occurring?

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Are You Thriving?

The constant additions of new programs and new methods, updates and consideration of changes is almost unbearable for some agencies.  Home Health has been hit really hard since 2008 and no relief seems to be coming.   Value-Based Purchasing, Pre-Claim Review, New CoPs, OASIS-C2, ICD-10 CM and now possibly major changes to the Prospective Payment System in regard to reimbursement.

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Late NOE Exceptions Clarified

Notices of Election (NOE) that are filed and/or accepted at the Medicare Administrative Contractor (MAC) outside of the required 5 calendar day requirement, penalizes the hospice and the hospice does not receive reimbursement for any services until the NOE is accepted at the MAC.  There have been some significant reimbursement issues with hospices due to this requirement, even when the issue was out of the control of the hospice and due to a Medicare system processing issue.

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Search Home Health in the NEAR Future!

The vice just gets tighter and tighter and the heat gets hotter!  Agencies are struggling to keep their heads above water and to keep up with the massive amounts of…

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NO OASIS Submission Equals NO Payment

The day has come that many agencies are going to be surprised by and that many have feared.  A long standing federal regulation requires the transmission and acceptance of the…

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2017 FINAL Home Health Rule

CMS released the 2017 Final Home Health Payment Rule on October 31, 2016. RATE CHANGES 2017 brings the 4th and final year of this round of rebasing.  Different from the…

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Reimbursement Impact of OASIS-C2

Effective January 1, 2107, home health is facing full implementation of OASIS-C2. One of the biggest changes, with OASIS-C2, is the treatment of Stage 3 and 4 pressure ulcers when the wound…

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The FOUR Questions!

Have you heard the latest?  Are you in the “know” regarding medical review documentation requirements of your Medicare Home Health Charts? Many of you know that the Pre-Claim Review Demonstration began…

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BREAKING NEWS – PRE-CLAIM REVIEW DELAYED

After much work and dedication from the Home Care Association of Florida (HCAF), the National Association for Home Care & Hospice (NAHC), wonderful Senators from Florida, other State Home Care…

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Pressure Ulcer Unlearning!

Unlearning: to put out of one’s knowledge or memory or to undo the effect of or discard the habit of.  This is what we have to do with most everything…

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OASIS-C2: Are you Prepared?

Hopefully your preparation for OASIS-C2 implementation has begun and due to that your Thanksgiving, Christmas and New Year’s Celebration will NOT be stressful. January 1, 2017 will bring with it…

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2017 Proposed Home Health Rule

CMS released the 2017 Proposed Home Health Payment Rule and while some things are a bit of a surprise, most are not. RATE CHANGES 2017 brings the 4th and final year…

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The Battle Over HbA1c Has Been Won!

For too long home health agencies, with Palmetto GBA as their Medicare MAC, have been fighting physicians over trying to get orders and information needed to meet the Local Coverage…

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Medicaid and F2F: The Day has Officially Arrived!

CMS recently issued a final rule that will require a Face-to-Face (F2F) encounter for Medicaid patients receiving home health services or Durable Medical Equipment (DME) and may expand coverage of…

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New G-Codes Not JUST for HOSPICE!

Change Request (CR) 9369 was released by CMS on Friday, October 16, 2015, providing Additional G-Codes that will differentiate Registered Nurses (RNs) and Licensed Practical Nurses (LPNs) in Home Health…

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Initials and Not a Full Signature, Allowed?

One of the things home health and hospices frequently have issues with is physician signatures. Often the issues surround the physician not dating their signature or making changes on hard…

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The Y2K of Coding!

Most of you will recall the scare that ran rampant throughout the country with Y2K, well basically the same thing happened with ICD-10 Coding. We were able to get a…

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Finally Some Relief or Not!

There is not much that is more frustrating than receiving a denial after submitting a chart to a reviewer, resolving the issue and then under appeal it is denied again…

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Home Care and Hospice: Still No Relief!

It was announced last week that Home Care and Hospice would receive NO relief from ICD-10 codes being required on Home Care and Hospice claims. Earlier this year, CMS issued…

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Cert and Recert Clarification for Home Health

Change Request (CR) 9189 was released July 10, 2015 was an implementation date of August 11, 2015. This CR was issued to update the Medicare Program Integrity Manual, Chapter 6…

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Are You Overwhelmed by it All?

It seems that everything is happening at once and agencies are beginning to feel the pressure, more than ever, to keep up with it all and make sure they reach…

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Are You Sending Everything Needed for Therapy ADR Review?

Effective April 1, 2015, Palmetto GBA is requiring additional therapy documentation for all Additional Documentation Request (ADRs) that contain continued therapy services into the subsequent episode. In addition to the…

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Are You Convinced Your Agency is ICD-10 Ready?

The Medicare Administrative Contractors (MACs) will be conducting both Acknowledgement Testing and End-to-End Testing for ICD-10 readiness. Agencies will not even need to register for Acknowledgement Testing. However, agencies MUST…

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Home Care Diabetic Patients Under The Microscope

Palmetto GBA’s Local Coverage Determination (LCD- L35413) regarding monitoring glucose control in patients with Type II Diabetes Mellitus was effective 12/30/14. The LCD contains specific requirements for Type II diabetic…

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Home Care Medical Necessity Documentation

Medical review of home care charts, from many different organizations, has haunted home care agencies over the past couple of years. Lack of adequate Face to Face documentation has led…

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Face to Face 2015 – What we know so far!

Happy New Year & Welcome to The HPS Blog There have been many concerns and questions surrounding the 2015 Home Care Face to Face (F2F) documentation requirements since the release…

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