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.

VIEW POST

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.

VIEW POST

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.

VIEW POST

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.

VIEW POST

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.

VIEW POST

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.

VIEW POST

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.

VIEW POST

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.

VIEW POST

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.

VIEW POST

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.

VIEW POST

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.

VIEW POST

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.

VIEW POST

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.

VIEW POST

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.

VIEW POST

Understanding the Impact Medicare Open Enrollment has on Your Agency

Medicare Open Enrollment runs from October 15 to December 7, granting patients the opportunity to switch from traditional Medicare to a Medicare Advantage plan or move from one Medicare Advantage plan to another. This time of year can be challenging, not only for your agency, which may be impacted by patients’ decisions, but also for patients and their families as they navigate the process and determine the best choices for themselves or their loved ones.

VIEW POST

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.

VIEW POST

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.

VIEW POST

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.

VIEW POST

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.

VIEW POST

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.

VIEW POST

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.

VIEW POST

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.

VIEW POST

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.

VIEW POST

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.

VIEW POST

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.

VIEW POST

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.

VIEW POST

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.

VIEW POST

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.

VIEW POST

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.

VIEW POST

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.

VIEW POST

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.

VIEW POST

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.

VIEW POST

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.

VIEW POST

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.

VIEW POST

2024 Medicare Eligibility Verification Strategies for Home Health and Hospice

As we enter the new year, it is crucial to conduct a new Eligibility Verification Run for every patient on your census in both Home Health and Hospice. This will ensure that the correct payer is billed for patient care.

VIEW POST

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.

VIEW POST

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.

VIEW POST

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.

VIEW POST

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.

VIEW POST

Open Enrollment of Medicare Advantage plans and the Impact it Could Have on Your Agency

In this Monday Minute, we discuss Open Enrollment for the Medicare benefit and the impact it could have on Home Health and Hospice agencies.

VIEW POST

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.

VIEW POST

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.

VIEW POST

Recent Changes for Medicare Home Health Billing

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

VIEW POST

Reviewing the July 2023 Home Health PEPPER Report

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

VIEW POST

Reviewing the 2024 Home Health Proposed Rule

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

VIEW POST

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.

VIEW POST

Updated ABN Form Mandatory Implementation June 30, 2023 (VIDEO)

In today’s Monday Minute, we discuss the updated Advanced Beneficiary Notice (ABN) Form.

VIEW POST

Understanding the Impact of PIPR Reports on Medicare Certified Home Health Agencies (VIDEO)

In this week’s Monday Minute, we discuss the latest updates to the Value-Based Purchasing model, specifically focusing on the April 2023 release of the Pre-Implementation Performance Reports (PIPR).

VIEW POST

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.

VIEW POST

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.

VIEW POST

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.

VIEW POST

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

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

VIEW POST

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.

VIEW POST

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.

VIEW POST

Reviewing April 1, 2023 ICD-10 Coding Updates (VIDEO)

In this Monday Minute, we discuss updates to ICD-10 codes that will go into effect April 1, 2023.

VIEW POST

The Impact of 2022 Omnibus Legislation on Home Health and Hospice (VIDEO)

In this Monday Minute, we discuss the content of the recently passed Omnibus budget legislation as it relates specifically to Home Health and Hospice.

VIEW POST

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.

VIEW POST

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.

VIEW POST

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.

VIEW POST

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.

VIEW POST

Medicare Open Enrollment and its Impact on Home Health and Hospice (VIDEO)

This Monday Minute discusses the Medicare Open Enrollment period and how that impacts both Home Health and Hospice agencies.

VIEW POST

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.

VIEW POST

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.

VIEW POST

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.

VIEW POST

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.

VIEW POST

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.

VIEW POST

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.

VIEW POST

Review Choice Demonstration Cycle Selection Update (VIDEO)

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

VIEW POST

2022 Home Health PEPPER Update (VIDEO)

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

VIEW POST

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.

VIEW POST

Value Based Purchasing Benchmarks & Achievement Thresholds (VIDEO)

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

VIEW POST

Home Health Claims & NOA Errors that Continue to Plague Agencies (VIDEO)

This Monday Minute reviews current claims processing issues and highlights of the penalty exception requests process.

VIEW POST

Sequestration is BACK! (VIDEO)

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

VIEW POST

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.

VIEW POST

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.

VIEW POST

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.

VIEW POST

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.

VIEW POST

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.

VIEW POST

Help Stop Sequestration through Advocacy Lead by the National Association for Home Care & Hospice (VIDEO)

This Monday Minute provides encouragement for agencies to assist in advocacy regarding the sequestration deduction that is soon to be reinstated.

VIEW POST

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.

VIEW POST

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.

VIEW POST

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.

VIEW POST

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.

VIEW POST

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.

VIEW POST

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.

VIEW POST

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.

VIEW POST

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.

VIEW POST

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.

VIEW POST

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.

VIEW POST

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.

VIEW POST

The Impact of Hurricane Ida

This Monday Minute will touch on the impact that Hurricane Ida has had on home health and hospice and exceptions granted by CMS to this area.

VIEW POST

Medicare Claims Processing Issues Logs (VIDEO)

This Monday Minute emphasizes the importance of reconciling payments to your AR and the significance of the Medicare MAC claims processing issues logs.

VIEW POST

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.

VIEW POST

Medicare Eligibility Verifications (VIDEO)

This Monday Minute will touch on the significance of Medicare Eligibility Verifications and a key update to the content of Workers’ Comp and Liability Policies in the Common Working File. We will point out something that we have discovered, that could be a significant help in situations where you do that Eligibility Verification, so watch to learn more about Medicare Eligibility Verifications to have a successful enrollment.

VIEW POST

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.

VIEW POST

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.

VIEW POST

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.

VIEW POST

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.

VIEW POST

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!

VIEW POST

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!

VIEW POST

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!

VIEW POST

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!

VIEW POST

Provider Relief Funds Reporting Update (VIDEO)

This minute covers the HHS revision of the Post-Payment Notice of Reporting Requirements as of June 11, 2021. This new version supersedes all previous versions of the Post-Payment Notice of Reporting Requirements documents. Make sure to stay tuned!

VIEW POST

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!

VIEW POST

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!

VIEW POST

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!

VIEW POST

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!

VIEW POST

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!

VIEW POST

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!

VIEW POST

Medicare Regulatory Update (VIDEO)

Welcome to Monday Minute with Melinda! This video clip will provides an update on Sequestration claims hold, Advanced & Accelerated Payments & Provider Relief Funds! Make sure to stay tuned!

VIEW POST

Accelerated and Advance Payment Recoupment to Begin (VIDEO)

Welcome to Monday Minute with Melinda! This video clip will recap the process of Medicare recouping the Accelerated and Advance Payments from 2020. Make sure to stay tuned!

VIEW POST

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!

VIEW POST

Wrap Your Arms Around the RAP – Request for Anticipated Payment 2021

Beginning 1/1/2021 the Request for Anticipated Payment (RAP) will no longer have a 20% payment associated with its processing. The RAP will continue to be a requirement for payment and ironically will be associated with a penalty if it is not accepted at the Medicare Administrative Contractor (MAC) by Day 5, the begin date of the payment period being Day 0. The penalty will be a daily amount as a proportion of the 30-day value related to the HIPPS code that the 30-day payment period is worth.

VIEW POST

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.

VIEW POST

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.

VIEW POST

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.

VIEW POST

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.

VIEW POST

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.

VIEW POST

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.

VIEW POST

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.

VIEW POST

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.

VIEW POST

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!

VIEW POST

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.

VIEW POST

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…

VIEW POST

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!

VIEW POST

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.

VIEW POST

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.

VIEW POST

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.

VIEW POST

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.

VIEW POST

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.

VIEW POST

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…

VIEW POST

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…

VIEW POST

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…

VIEW POST

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…

VIEW POST

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…

VIEW POST

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.

VIEW POST

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.

VIEW POST

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…

VIEW POST

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…

VIEW POST

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…

VIEW POST

How To Access The Provider Statistical & Reimbursement Report

It is that time of year again. Cost report season for home health and hospice providers. Cost reports are due five months after your agency fiscal year end. For agencies with a 12/31/16 fiscal year end cost reports are due by 05/31/17.

VIEW POST

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?

VIEW POST

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.

VIEW POST

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.

VIEW POST

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.

VIEW POST

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…

VIEW POST

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…

VIEW POST

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…

VIEW POST

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…

VIEW POST

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…

VIEW POST

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…

VIEW POST

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…

VIEW POST

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…

VIEW POST

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…

VIEW POST

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…

VIEW POST

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…

VIEW POST

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…

VIEW POST

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…

VIEW POST

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…

VIEW POST

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…

VIEW POST

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…

VIEW POST

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…

VIEW POST

The Complexities of Medicare Secondary Payer Billing

Medicare has always looked to liability insurance policies, no-fault insurance policies, and workers’ compensation plans to pay for services related to injuries associated with those policy types. Recent changes to…

VIEW POST

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…

VIEW POST

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…

VIEW POST

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…

VIEW POST

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…

VIEW POST

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,…

VIEW POST

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…

VIEW POST

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…

VIEW POST

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…

VIEW POST

Medicare Web Portals – Navigating the “Dark Days”

Home Care and hospice providers usually rely on the Medicare DDE system or their software systems for Medicare eligibility verifications. Some agencies leverage their relationship with various network service vendors…

VIEW POST

Home Care HIPPS Code Corrections When Re-Coded

For Home Care agency collectors there has been a seemingly never-ending saga of research, in many cases, to ensure that the agency was paid appropriately by Medicare. At the core…

VIEW POST

Medicare Managed Care – Can it be Managed? (Part Three)

This, the final article in a series of three, will focus on the all-important billing and collections aspect of your relationship with managed care payers. Proper credentialing and meticulous attention…

VIEW POST

Medicare Managed Care – Can it be Managed? (Part Two)

Our last article focused on the complexities of the credentialing process with managed care payers. Part two of this three part series will focus on what happens after credentialing, specifically…

VIEW POST

Medicare Managed Care – Can it be Managed?

As Medicare reimbursement cuts continue agencies will be forced to expand into the managed care and private insurance markets. Doing so is a complicated process that involves contracting, intake process…

VIEW POST

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…

VIEW POST

OASIS to Claim Data Matching

Medicare determines payments of home care claims using case-mix groups derived from the OASIS assessments of the beneficiary. Home care agencies submit the case-mix groups on their claims as a…

VIEW POST

Home Care Final Rule 2015: Case-Mix & CBSA Changes!

The 2015 Home Care Final Rule has brought about MANY changes in the home care calculations for payment in addition to the Face to Face (F2F) changes that were discussed…

VIEW POST

Home Care Final Rule 2015: Case-Mix & CBSA Changes!

The 2015 Home Care Final Rule has brought about MANY changes in the home care calculations for payment in addition to the Face to Face (F2F) changes that were discussed…

VIEW POST