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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Takeaways from the 2026 Home Health Proposed Rule & Guidance for Submitting Effective Comments

The newly released 2026 proposed rule for home health brings significant implications for our industry—below are key takeaways and guidance to help you craft impactful comments during the open comment period.

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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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Explaining the Upcoming ICD-10 Coding Update that will Take Effect October 1

Updates to ICD-10 occur twice each year—once in April and again in October. An upcoming ICD-10 coding update will take effect on October 1. While the April releases may bring some changes, and occasionally none at all, the October update is typically more significant.

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Understanding the Latest Clarifications on Home Health Face-to-Face Requirements

Face-to-Face Encounters are once again a central topic of discussion in Home Health. The regulation has been in place since 2011, with an update issued in 2015. Since April 1, 2015, the regulation itself has remained unchanged. However, over the past decade, including in 2025, there have been numerous clarifications.

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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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Addressing Outpatient Code Editor Error that is causing Home Health Billing Rejection Frustrations

A home health billing rejection issue is leading to significant frustration and needs to be addressed. On April 25th, 2025, CMS issued Change Request 13992 to update the Outpatient Code Editor.

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How Home Health and Hospice Agencies can Submit Input to Influence Healthcare Deregulation

An important opportunity is now available for healthcare providers to help reduce outdated and burdensome regulations across the industry. The Hospice Proposed Rule was issued a couple of weeks ago, along with a request for information focused on deregulation across the healthcare industry.

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Understanding the Future of Medicare Cost Reporting for Home Health and Hospice Agencies

In the coming months, an important topic that will become a priority for many home health and hospice agencies is the submission of your annual Medicare Cost Report. The OIG recently released a report after auditing Cost Reports to evaluate whether Medicare MACs were effectively overseeing Medicare Cost Report filings. Their findings were less than favorable.

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Telehealth for Face-to-Face Encounters has been Extended until September

We’re excited to share that the use of telehealth for face-to-face encounters has been extended until September 30, 2025. The extension permits both home health and hospice to continue conducting face-to-face encounters on behalf of home health.

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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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Understanding Important Updates Regarding Credit Balance Reports and Telehealth Face-to-Face Encounters

Two important updates from the end of 2024 need to be communicated to both home health and hospice teams regarding Credit Balance Reports and Telehealth Face-to-Face Encounters.

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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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Reviewing Changes Outlined in the OASIS-E1 Final Guidance Manual

The updates include the addition of one new item to the OASIS. Additionally, two items will be removed entirely, a change anticipated due to their limited relevance in OASIS calculations. Three existing items have been revised refer to the manual for further details on those updates. Lastly, the skip pattern for M0102 has been updated.

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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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Reviewing Updates to the Home Health Quality Reporting Program

In October 2024, the data on the Care Compare site was refreshed. With this update, the Acute Care Hospitalization and Emergency Department measures were removed.

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CMS Waivers and Donation Efforts in the Wake of Hurricanes Helene and Milton

As the Southeast grapples with the aftermath of recent hurricanes, communities are coming together to support one another during these challenging times. The devastation wrought by these storms has been profound, and with that comes information regarding waivers that CMS has issued.

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Reviewing Rare Updates to the 2025 Home Health Consolidated Billing Listing

Since its introduction approximately 20 years ago, changes to the Home Health Consolidated Billing listing have been rare. In the most recent release of the 2025 listing, 71 new codes have been added to the listing.

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Understanding Updates to the Home Health Quality Reporting Program

Many updates have been released in relation to the Home Health Quality Reporting Program. The first of which pertains to the HHCAHPS Star Ratings Preview Reports that were released in September, and will influence the Care Compare update coming in October 2024.

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CMS Releases Preview Annual Performance Reports for the Home Health Value-Based Purchasing Model

CMS has recently released the Preview Annual Performance Reports for the Home Health Value-Based Purchasing Model. You can access these reports in the iQIES system, where you’ve been reviewing the Interim Performance Reports (IPR). This Preview Report introduces, for the first time, the percentage calculations showing how your 2023 results will affect your 2025 payments.

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Reviewing Wage Index and CBSA Classification Changes in the 2025 Home Health Proposed Rule

In addition to the Hospice Proposed Rule having many updates related to the Wage Index and CBSA classifications, the Home Health Proposed Rule also outlined several updates. Though both contained updates, there are occasional differences in the wage index results between home health and hospice.

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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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Mastering Managed Care: Strategies for Success in the Evolving Home Care Landscape

Reimbursement stands out as a primary concern among home care providers. Over time, we’ve witnessed a shift in the landscape, moving from 90%-100% reliance on traditional Medicare to a mix where only 40%-50% comes from traditional Medicare. For those not yet engaging with managed care, this shift has likely impacted their census.

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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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New Change Request Could Cause Payment Delays for Home Health and Hospice Agencies

CMS has issued a Change Request, number 13449, titled “Stay of Enrollment”, and it is crucial that home health and hospices agencies, as well as other suppliers such as Physicians and Durable Medical Equipment (DME) providers all understand this request.

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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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Quarter One 2024 OASIS Updates & Guidance Manual Changes

2024 ushered in a myriad of changes implemented by the Home Health Final Rule as well as annual updates to the OASIS Guidance Manual. Since so much of our industry’s performance and quality assurance practices rely on data, these updates are important to implement to ensure we are reflecting the care we are delivering accurately.

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Important Updates to Interpretive Guidelines for Home Health Surveys

In the March update, several changes have been made to the Interpretive Guidelines for Home Health Surveys. From clarifications to comprehensive assessments to nuanced adjustments in infection prevention protocols, each change adds layers of complexity for agencies striving for excellence in home health care delivery.

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Take Action Today: Two Ways to Support your Home Health Agency’s Future

Healthcare Provider Solutions is requesting your participation in two important endeavors that are tailored to support your home health agency now and in the future. The first request is the Medicare Advantage Survey and the second is to attend NACH Spring Advocacy Day.

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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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Navigating the Playing Field – Part 2: Mastering the Game of Medicare Advantage

With Medicare Advantage on the rise how can your agency knock it out of the park and use it to your advantage? Before you run the bases it is important to know your opponent.

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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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Release of New OASIS-E1 Draft Details Several Upcoming Changes

A draft of the new OASIS-E1 has been released. This revised version is set to take effect on January 1, 2025.

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The War Against the Behavioral Adjustment and How You Can Help

Since the release of the Home Health Proposed Rule in July of 2023 for 2024, the significance of the Behavioral Adjustment has been strongly emphasized – it’s a war we are losing and need to take action on.

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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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Navigating the Playing Field: Understanding the Significance of Medicare Advantage on Home Health Agencies

Explore the intricacies of Medicare Advantage Plans and their impact on Home Health Agencies. Gain insights into the rapid growth of these plans, their coverage, and the challenges they pose to care providers.

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Nationwide Call for Advocacy for Home Health Agencies Battling Devastating Rate Alterations

Advocacy is needed for front-line home health agencies voicing their concerns about devastating rate changes.

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Recent Changes for Medicare Home Health Billing

In this Monday Minute, we discuss some recent changes concerning the billing of home health claims.

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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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Your Voice Matters: Advocacy Needed for the Home Health Industry

In this week’s Monday Minute, we highlight a crucial home health advocacy effort that requires your active participation.

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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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Discussing CMS Call regarding the Behavioral Adjustment Being Applied to Home Health Rates (VIDEO)

In this week’s Monday Minute, we discuss the challenges faced by the Home Health industry regarding the calculation of behavioral adjustment rates.

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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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The Current State of TPE and How to Avoid Common Claim Denials for Home Health and Hospice

Discover the current state of TPE for Hospice and Home Health providers, along with the top claim denials and strategies on how to avoid them to prevent negative financial impacts.

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Clarifying New Telehealth G-Codes for Home Health Claims (VIDEO)

In this Monday Minute, we clarify the new G-Codes for telehealth encounters.

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High-Level Advocacy Efforts Needed for Home Health and Hospice Providers (VIDEO)

In this Monday Minute, we discuss the need for high-level advocacy efforts and how you can participate in the March on Washington to fight back against negative regulatory decisions in our industry.

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Public Health Emergency Planned to End on May 11, 2023 (VIDEO)

In this Monday Minute, we discuss the end of the Public Health Emergency and its impact on telehealth and more.

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Is a Mock Survey in my Home Health or Hospice’s Best Interest?

Discover the importance of mock surveys for home health and hospice agencies and how they can help identify any weaknesses before an actual survey occurs.

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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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Sudden Reactivation of Code 31755 and the Impact it Has on Claims (VIDEO)

In this Monday Minute, we discuss CMS reactivating billing reason code 31755 edit without warning and how that affects claims.

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Advocacy Needed in Home Health and Hospice to Prevent Rate Cuts (VIDEO)

In this Monday Minute, we discuss the needed advocacy for Home Health and Hospice to prevent rate cuts.

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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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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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Department of Health and Human Services Extends Public Health Emergency to January 11, 2023 (VIDEO)

In this week’s Monday Minute, we discuss the announcement made by the Department of Health and Human Services that the Public Health Emergency has been extended for an additional 90 days.

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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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Telehealth Used for Face-to-Face to Extend Beyond Termination of the Public Health Emergency (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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Advocacy Needed to Preserve Access to Home Health (VIDEO)

This Minute is to spark needed advocacy on behalf of home health agencies nationwide to stop the reduction of home health rates that were proposed by CMS.

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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 Highlighted Changes (VIDEO)

This Minute will review, at a very high level, some significant changes involved with OASIS-E implementation.

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2022 Home Health PEPPER Update (VIDEO)

This Minute will review highlights of the July 2022 release of the updated PEPPER.

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2023 Home Health Proposed Payment Rule (VIDEO)

This Minute will do a high-level review of the reimbursement and Value-Based Purchasing proposed changes for 2023.

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Transmittal Regarding NPP Oversite has been Rescinded (VIDEO)

This Minute will review the requirement that CMS tried to implement regarding collaboration with physicians when a NPP is certifying and/or signing home health orders and the result of the challenge, in the original transmittal being rescinded.

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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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Value Based Purchasing Benchmarks & Achievement Thresholds (VIDEO)

This minute reviews details surrounding the release of the baseline year benchmarks and achievement thresholds.

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Sequestration is BACK! (VIDEO)

This Monday Minute will review the sequestration deduction that is once again being applied to all Medicare payments.

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Brief Announcement Regarding Medicare Advantage (VIDEO)

This Monday Minute will briefly review the recent CMS rule regarding cost-sharing and the phases of VBID preparation for 2023.

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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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PEPPER Reports 101: What You Need to Know (VIDEO)

In this video, we will go in detail about what PEPPER Reports are and what they entail.

Industry educator, Melinda A. Gaboury, discusses the importance of PEPPER Reporting for your agency and how it relates to medical review. It’s imperative that someone within your organization immediately obtains access to the PEPPER Reports and begins to analyze exactly where your agency stands.

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HHCAHPS Impact on Value Based Purchasing & the Exemption Deadline (VIDEO)

This Monday Minute will highlight the deadline for HHCAHPS Participation Exemption and review the impact that the HHCAHPS results will have on Value Based Purchasing as it is rolled out in January 2023.

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Update on the Notice of Admission NOA 2022 (VIDEO)

This Monday Minute will review the confirmed requirement that all home care agencies will have to request exception on ALL late NOAs, even if it was a MAC claims processing system error.

We will provide the links to the Medicare MAC websites, specifically to the claims processing logs.

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Care Compare January 2022 Refresh for HHQRP

This Monday Minute will take you through the highlights of the January 2022 Care Compare refresh of data.

We will provide a link to the updated Tips Report which gives you all of the information discussed in this minute plus more.

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Telehealth During the Continuing Public Health Emergency (VIDEO)

This Monday Minute navigates the details of what can and can not be done regarding Telehealth during the current Public Health Emergency.

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Public Health Emergency Extension (VIDEO)

This Monday Minute will highlight the issues related to the Public Health Emergency as it impacts home health and hospice waivers.

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The NOA Kicks 2022 off with a Bang! (VIDEO)

This Monday Minute reviews the current situation with the Notice of Admission and some key thoughts about moving forward.

The Medicare Home Health Notice of Admission has been what some would call a nightmare. All three of the Medicare MACs have had some level of issue with correct processing.

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NOA, Hospice Medical Review & Sequestration is Back! (VIDEO)

This Monday Minute will review the TOP concerns moving into 2022, including the sequestration deductions beginning again. We want to share with you a couple of things on the three most important transitional things as we move into 2022 for both Home Health and Hospice.

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Notice Of Admission: The Lowdown On The Request For Anticipated Payment’s Successor

Do you have questions about the transition from Request for Anticipated Payment to Notice of Admission in 2022? This article will detail what is the same, what is different, and how to navigate the crossover periods. The RAP has been a part of home health for more than two decades. It may be hard for some to see it be retired, but there will be others who are going to celebrate. The NOA will boldly make its presence known in 2022 and hopefully bring some relief from the anxiety of the RAP requirements every 30 days.

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Notice of Admission 2022: EMR Failures (VIDEO)

This Monday Minute will review the critical aspects of the Notice of Admission that includes the cross-over periods from 2021 and the necessity of access to the Direct Data Entry (DDE) system.

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2022 Home Health Final Rule Includes DELAY in VBP (VIDEO)

This Monday Minute will review the 2022 Home Health Final Rule highlights, including the exciting announcement that Value Based Purchasing will be delayed until 2023. With this nationwide rollout being put off until January 2023, CMS is allowing for agencies to receive additional education to be able to figure out exactly how this Value Based Purchasing process works and be able to more fully understand how your agency can be successful under the Value Based Purchasing Model.

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The Extension of the Public Health Emergency (PHE) (VIDEO)

This Monday Minute will review the extension of the Federal Public Health Emergency, share some concerns that may impact agencies at the state level and some very important things to note regarding this extension of the PHE. It was set to expire in October of 2021 but now has been extended to the third week of January of 2022.

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Hospice and Home Health PEPPER Reports (VIDEO)

This Monday Minute discusses the impact that PEPPER Reports can have on a Home Care or Hospice agency. We also share the information needed to access your agency’s PEPPER Reports and when these reports are released annually.

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Phase 4 Provider Relief Funds and 60-day Grace Period (VIDEO)

This Monday Minute reviews the content of the HHS announcement regarding the, now available, $25.5 billion in additional provider relief funds. 8 billion of this money is to be given to small providers primarily in rural areas and bonuses will be given to providers that serve primarily Medicaid, CHIP and/or Medicare patients.

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Implementation of the Notice of Admission (VIDEO)

This Monday Minute will take you through the key elements of the coming Notice of Admission and provide references. We want to share with you a document that was published by Palmetto GBA, CGS and NGS, all three of the Home Health Medicare MAC’s this past week. This document goes through the details of what is going to be included in the Notice of Admission, beginning January 1st of 2022.

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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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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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More Details on the 2022 Home Health Proposed Rule (VIDEO)

This minute covers more details on the 2022 Home Health Proposed Rule. Register for our June15th webinar for more in depth information. Make sure to stay tuned!

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The Home Health Proposed Rule 2022 (VIDEO)

This minute covers some of the changes for the Home Health Proposed Rule that were released on June 21st. Make sure to stay tuned!

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OSHA Emergency Temporary Standard (VIDEO)

This minute covers the COVID-19 Healthcare ETS (Emergency Temporary Standard) being officially filed in the Office of the Federal Register on June 17, 2021, and it became effective when it was published on June 21, 2021. Make sure to stay tuned!

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Increase in COVID-19 Vaccine Administration Payments (VIDEO)

This minute covers the news release from CMS concerning: Medicare Billing for COVID-19 Vaccine Shot Administration. Effective June 8 of 2021, CMS has now approved that the COVID vaccination administration payment is going to be $75 per shot, which is almost double what they had increased it to earlier this year. The emphasis on getting as many people vaccinated as we possibly can is apparent. Make sure to stay tuned!

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Post Payment Reviews Inside the Public Health Emergency (VIDEO)

This minute covers the news release from CMS concerning, MACs Resume Medical Review on a Post-payment Basis. Beginning August 2020, Medicare Administrative Contractors (MACs) resumed post-payment reviews of items and services with dates of service before March 2020. MACs may now begin conducting post-payment medical reviews for later dates of service. 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 (VIDEO)

Today’s video clip covers the Updated Guidance for Emergency Preparedness memo released in March of 2021. You need to thoroughly review all of the changes that have taken place in this update. Make sure to stay tuned!

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Notice of Admission Transmittal (VIDEO)

This Minute covers the highlights of Transmittal 10758, dated May 11, 2021 with updates to the Medicare Claims Processing Manual regarding the NOA implementation for January 2022. 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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The HEAT Act (VIDEO)

Welcome to Monday Minute with Melinda! This Minute is a call to action regarding the Senate bill the HEAT Act. Please review and participate. Make sure to stay tuned!

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COVID Vaccine Administration Billing Update & Extension of the Public Health Emergency (VIDEO)

Welcome to Monday Minute with Melinda! This session reviews the details of the Condition Code that must be used in billing vaccine administration for Medicare Advantage enrolled patients. Additionally, we touch on the extension of the PHE and corresponding CMS Waivers. Make sure to stay tuned!

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Sequestration, Reminder Regarding NPPs in Home Health & Update on Claims Processing (VIDEO)

Welcome to Monday Minute with Melinda! Welcome to Monday Minute with Melinda! This session is loaded with updates regarding sequestration, claims processing and the use of NPPs in Home Health. Make sure to stay tuned!

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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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Revisions to Infection Control and Practices during COVID-19 PHE

The Center for Clinical Standards and Quality/Quality, Safety & Oversight Group released a QSO-21-08-NLTC (Non Long Term Care) on December 30, 2020 to State Survey Agency Directors. This QSO revised the COVID-19 Focused Infection Control (FIC) Survey Tool for Acute and Continuing Care, of which home health and hospice are a part.

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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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Home Health Proposed Payment Rule CY2021

CMS released the CY 2021 Home Health Proposed Payment Rule in June 2020. The proposed rule contains several updates and changes. These changes include PDGM Rates, Wage Index, Telehealth, Quality Reporting Program, and Billing RAPS. The RAP issue alone is enough to warrant EVERY agency in the nation sending in comments and requesting that this be changed! We must stand together.

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New Advanced Beneficiary Notice of Noncoverage (ABN) – Home Health and Hospice

CMS announced the renewal of the Advanced Beneficiary Notice (ABN). The new ABN form is effective for use on or after August 31, 2020. Home Health and Hospice Providers need to ensure they are using the most current form. All Medicare Beneficiaries and Healthcare Providers have rights and are protected against financial liability through an Advanced Beneficiary Notice (ABN). Home Health providing care under Part A or Part B and Hospice providers under Part A are responsible for giving this notice to the beneficiary in situations where Medicare payment is expected to be denied.

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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: Emergency Financial Relief for Home Health & Hospice Providers

(UPDATED – 05/14/2020) The CMS Accelerated and Advance Payments Program program was suspended on April 26, 2020 and no further Accelerated Payments are happening at this time. During this Public Health Emergency (PHE) there are several avenues of obtaining cash to keep your agency going. This article addresses two of those. The Accelerated and Advance Payments Program allows agencies to get an advance on Medicare payments and it must be repaid. The other is the CARES Act Provider Relief Fund that is being automatically disbursed. Agencies will not need to repay these funds, however, there are accountability requirements for accepting and using these funds.

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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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Are You Prepared? The Patient Driven Groupings Model (PDGM) Is Coming Soon

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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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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Agencies at Risk for Missing FIPS Codes

Home Health Agencies across the country are at risk for penalties and recouped claims if the FIPS code is NOT reported on ALL CLAIMS!

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2019 Rural Add-On Changes

As if the changes in the payment system were not enough. Based on the 2019 Medicare Home Health Final Rule, released in early November 2018, the Rural Add-On is being completely revised.

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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 Value Based Purchasing Proposed Changes (UPDATED)

The Centers for Medicare and Medicaid Service (CMS) finalized all of the proposed changes to the Value-Based Purchasing (VBP) Model for implementation January 1, 2019. One of the refinements of VBP removed five measures, while adding two new composite measures.

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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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Home Health MedPAC Report to Congress

Each year the Medicare Payment Advisory Commission (MedPAC) submits its annual report to Congress which contains information and recommendations related to Medicare fee-for-service (FFS) programs. This article details the 2018 annual report recommendations for Home Health.

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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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CAHPS – Home Health & Hospice

Are you monitoring the agency’s CAHPS results? There are numerous questions on the survey that the patients must complete, but only selected ones go into the outcome measure calculations. Home Health CAHPS results have been reported on the Home Health Compare website for quite some time, while the results for the CAHPS Hospice Survey just began being public reported on Hospice Compare 02/22/18. One of the lowest scoring…

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HHCCN, ABN, NOMNC – Which Form Do I Use?

Home health providers may find themselves bombarded by forms and paperwork on a daily basis and find it difficult to remain compliant in utilizing the most up-to-date forms. This blog will briefly discuss the current versions of the Home Health Change of Care Notice (HHCCN), Notice of Medicare Non-coverage (NOMNC), and the Advance Beneficiary Notice (ABN) forms.

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Home Health & Hospice PEPPER Reports

Over the past couple of years, HPS has reported and discussed that Home Health and Hospice PEPPER Reports are very important and should be reviewed by all agencies. We have also been open about the number of agencies in the country that have never opened the reports. HPS is happy to report that, for the 8 months ending December 20, 2017, 58.5% of all hospices have opened their reports. Only 5 states and 1 territory are below 50%. The sad news is that home care…

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New Medicare Beneficiary Identifiers

HPS has given you a couple of updates on the new Medicare Beneficiary Identifier (MBI) cards over the past few months and we continue that update today. Following are more questions answered about the new Medicare numbers and how that will affect your agency. Key dates to remember: April 1, 2018 – Patients will begin to receive new Medicare cards and agencies should begin the process of asking…

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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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New Medicare Cards – Questions Answered

HPS reported on the coming changes to the Medicare cards a few months ago. Today we offer more answers as have been gathered from CMS via the Medicare Learning Network page of the CMS site. The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, requires the removal…

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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 Care & Hospice Emergency Preparedness

We will continue to update this article to keep you informed on the latest concerning Home Care & Hospice Emergency Preparedness. UPDATE – July 7, 2017 – Since the release of this article, the interpretive guidelines for emergency preparedness have been released. HPS has created a detailed table for Home Health and Hospice providers to assist our Alliance members in managing the EP information…

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Changes Coming to Medicare HIC Numbers – Medicare Beneficiary Identifier

Former President Harry S. Truman was the very first Medicare beneficiary to be issued a Health Insurance Claim Number (HICN) when then President Lyndon B Johnson signed the Medicare program into law on July 30, 1965. Ever since then, Medicare beneficiaries upon entitlement, have been issued a Health Insurance Claim Number (HICN). The primary issuer of the HICN is the social security administration with the railroad retirement Board issuing HIC numbers for railroad workers. Beginning in 2018 the Medicare HIC number will be replaced with a new identifier called a Medicare Beneficiary Identifier (MBI). The MBI numbers will be…

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Home Health PEPPER is HOT!

One of the Hot Topics surrounding the medical review contractors and Medicare MACs is Home Health PEPPER (Program for Evaluating Payment Patterns Electronic Report)! Pepper is an accumulation and calculation of certain statistics that result from claims data. These Medicare claims data statistics are calculated for areas that may be at risk for improper Medicare payments such as…

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HHCAHPS – Improvement in Specific Care Issues

Are you monitoring the agency’s HHCAHPS Star Ratings? There are numerous questions on the survey that the patients must complete, but only selected ones go into the outcome calculation and eventual star rating. The Composite Measure – Specific Care Issues, seems to be one that most agencies struggle with. The specific questions from the survey…

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Negative Pressure Wound Therapy with a Disposable Device Billing Specifics (NPWT)

The 2017 Final Home Care Rule included clarification that payment for the NPWT device is when a HHA “furnishes NPWT using a disposable device” to mean when the HHA provider is either initially applying an entirely new disposable NPWT device, or removing a disposable NPWT device and replacing it with an entirely new one.

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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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Are you G Code Savvy?

Many have not yet realized that there were additional G codes introduced that went into effect January 1, 2017. These codes were not a part of the 2017 Home Health Final Rule, but were introduced in the CR9736 issued November 10, 2016.

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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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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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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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The Continued Culture Change to Quality

When agencies take a hardcore look at what the culture of the agency is today, they will typically find that concern at monthly meetings revolves around drops in number of…

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Culture of Quality

How hard is it to develop a culture? One definition of culture: A culture is a way of life of a group of people–the behaviors, beliefs, values, and symbols that…

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Can You Afford to Ignore?

Home Health Agencies across the country face continuing payment cuts in all aspects of their payer mix.  Medicare, Medicare Advantage, Medicaid and commercial payers continue to cut rates and in…

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Will it Ever End? – Medicare Prior Authorization!

The initiatives to stop Medicare Fraud and Abuse are becoming more numerous and cumbersome. How much more are agencies going to be able to endure?  The most recent is the announcement…

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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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Value Based Purchasing: What We Weren’t Sure of!

Value Based Purchasing is alive and well and dwelling within Nine States! Agencies have been hard at work preparing for this and continue to strive toward being the best that…

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2016 HHRG Tables & Hospice CBSAs!

2016 Prospective Payment System (PPS) Rates are just around the corner for home health! These rates will be in effect for episodes ENDING 01/01/16. When the final claim is proposed…

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2016 HHRG Tables & Hospice CBSAs!

2016 Prospective Payment System (PPS) Rates are just around the corner for home health! These rates will be in effect for episodes ENDING 01/01/16. When the final claim is proposed…

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Ushering In 2016 – Kick off the Year Right!

With the ushering in of 2016 there comes a great many changes that will affect both home health and hospice. 1. New G-Codes to distinguish between RN (G0299) and LPN/LVN…

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2016 Home Health Rates Continued Decline!

CMS issued the Home Health Final Rule for 2016 and while the Value Based Purchasing (VBP) is a huge deal, agencies do not need to overlook the reimbursement impact of…

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The Nervous Nine Have Been Confirmed!

Are you one of The Confirmed Nervous Nine? The Nervous Nine are the Nine States that have been selected for the Value-Based Purchasing (VBP) Pilot Program under the Medicare Home…

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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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Is Canceling RAPs a Strategy for your Agency?

Typically the Home Health and Hospice Medicare MACs follow each other when one begins a new review, develops a new LCD, etc. Palmetto GBA (PGBA) is the largest Medicare MAC…

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CMS Issues 2016 FINAL Hospice Rule – Part 2

The FINAL Hospice Payment Rule was released on July 31, 2015 and addresses payment reform. Additionally, the 2016 Final Hospice Rule addresses the Aggregate Cap changes. The 2016 cap year,…

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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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2016 Proposed Rates Cannot Be Ignored!

As I am sure everyone has heard by now, CMS issued the Home Health Proposed Regulation for 2016 rates and Value Based Purchasing (VBP) Pilot on July 6, 2015! There…

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The Nervous Nine!

Are you one of The Nervous Nine? The Nervous Nine are the Nine States that have been selected for the Value-Based Purchasing (VBP) Pilot Program under the Medicare Home Care…

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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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Are Agencies Up to Date on Revalidation Requirements?

All agencies must participate in the revalidation process. This requirement has been updated by the Change Request (CR) 9011 that was recently issued with an effective date of 05/15/15. This…

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Additional Development Request Checklist

Agencies continue to report receiving Additional Development Requests from their respective Medicare Administrative Contractors (MAC). Unless your agency is one of the lucky few, you have experienced the anxiety first…

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2015 Therapy Compliance Changes

Since 2011, home care agencies have suffered under the administrative burden of stringent therapy reassessment requirements that required a therapy reassessment visit for each discipline of therapy at least once…

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