Guidance for HOPE Tool Access for Transmissions

Today, we’ll be addressing updates to the Hospice Quality Reporting Program. A newly released 5-part video series is now available to support training on the HOPE tool. The first of the five-part series offers an introduction and general overview of HOPE.

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2026 Hospice Final Rule Released

The 2026 Hospice Final Payment and Regulatory Update Rule was published on August 1 and aligns closely with what was outlined in the proposed version, confirming anticipated provisions and updates.

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Understanding Updates to the Hospice Quality Reporting Program

Today, we’ll be addressing updates to the Hospice Quality Reporting Program. A newly released 5-part video series is now available to support training on the HOPE tool. The first of the five-part series offers an introduction and general overview of HOPE.

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Hospice Trends to Watch: What CMS Monitoring Data Reveals

A recent report on Hospice Monitoring by CMS presented statistics that provide a clear view of current trends and may highlight key areas for evaluation within your organization. The data is compelling and serves as a valuable resource for understanding how hospice agencies are performing across various metrics.

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Preparing for HOPE: Key Updates to Guidance Manual Ahead of the October 1 Implementation

In the last week of April, a new version of the Guidance Manual for completing the HOPE tool was released, along with an updated version of the HOPE itself. That manual includes several updates, a few of which I’ll be sharing with you today.

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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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Reviewing Updated Information on the CAHPS Hospice Survey

In a previous Monday Minute, we reviewed significant changes to the CAHPS Hospice Survey. In that Minute, we mentioned that we would be sharing additional details as we got closer to the implementation phase. Today, we are providing the latest updates on the survey.

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Reviewing Significant Changes to the CAHPS Hospice Survey Set to Take Effect on April 1

Major updates to the CAHPS Hospice survey, which were outlined in the Hospice Final Rule released August 2024, will take effect April 1, 2025. Related documents for the CAHPS survey changes are dated online January 2025. It’s essential to confirm that your CAHPS vendor is ready to implement the new processes and forms by April 1.

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Self-Reporting your Hospice Aggregate Cap: Reviewing the Details

We have approached the time of the year to address the self-reporting of your Hospice aggregate CAP. For this year, the aggregate CAP must be submitted by February 28, 2025, and will cover the fiscal year ending on September 30, 2024.

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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 Hospice Year in Review and Looking Forward to 2025

As we close out 2024, Hospice has had a roller coaster ride for sure during this year and that will continue into 2025.

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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.

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Reviewing Important HOPE Tool Information in the 2025 Hospice Final Rule

The Hospice Outcomes and Patient Evaluation Tool, or HOPE Tool, is a clinical assessment tool that will completely replace the HIS, and will be mandatory for all patients, regardless of their payer or age. The HOPE Tool has been in development for quite some time and, although it was finalized in the 2025 rule, it won’t officially take effect until October 1, 2025.

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CMS Provides Clarifications on the Conclusion of the Hospice VBID Demonstration

Earlier this month, CMS released new information regarding the development that the hospice VBID demonstration would be terminated, effective December 31, 2024. With the VBID demonstration ending, there were many questions regarding the impact on patients, specifically concerning payers and benefits.

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PECOS Requirement Update Outlined in FAQ Document Released by CMS

The Centers for Medicare & Medicaid Services (CMS) released a Frequently Asked Questions (FAQ) document regarding the PECOS enrollment requirement for certifying Hospice physicians, effective June 3. This document clarified important details that must be understood about your claims processing.

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New Draft Legislation Released Could Affect Hospice Payment and Integrity Programs

On June 13, a congressman from Oregon released a comprehensive draft addressing changes in hospice payment and integrity programs. This proposed legislation has the potential to significantly affect hospices nationwide.

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Understanding the Two Hospice Quality Reporting Program Requirements Hospices Must Comply with to Avoid Payment Reductions

In order to avoid a 4% reduction in your upcoming annual payment update, it is essential that hospices are compliant with the Hospice Quality Reporting Program. These Hospice Quality Reporting Program requirements have been established for a while, yet every summer, many hospices across the nation are unexpectedly finding themselves non-compliant with specific aspects of these requirements.

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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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Understanding the Proposed Adjustments to CAHPS Hospice Surveys

CAHPS Hospice Surveys have been a longstanding component of the hospice program. These surveys have presented challenges for hospices, not only in terms of their content but also in securing the responses needed to make an impact on outcome measures. In the 2025 Hospice Proposed Rule, many proposed adjustments to CAHPS Hospice Surveys are on the table.

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Strategies for Navigating the Surge of Home Health Medical Reviews

Home Health Medical Review is experiencing another surge, although not as significant as the escalation observed in hospice. Nevertheless, it’s proving to be a challenge for several home health agencies.

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VBID Model Hospice Carve-In to End in December 2024

The Value-Based Insurance Design (VBID) model has included a hospice carve-in since 2021. Shockingly, it has been announced within the VBID demonstration framework that the hospice carve-in will conclude on December 31, 2024.

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Understanding the Top Two Reasons for Hospice Medical Review Denials

In today’s Monday Minute, Melinda discusses two of the most crucial causes for denial in hospice medical review and outlines proactive measures to avoid them. An increase in denials is occurring due to two very important hospice medical review topics – the Face-to-Face Encounter and the Certificate of Terminal Illness.

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

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

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3 Ways to Avoid Hospice Election Statement Denials

Numerous hospice agencies are dealing with denials due to a prevalent medical review issue, specifically related to the Hospice Election Statement.
The Election Statement was updated in October 2020, emphasizing the inclusion of three specific components.

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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.

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2024 Value-Based Insurance Design (VBID) Model Update

Under the VBID model, hospices are subject to the activity involved in the demonstration when a patient is enrolled in one of the participating benefit plan packages. In September 2023, the VBID demonstration participation list was updated, as it is every September, for the period of January through December of 2024.

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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.

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Addressing Recent Updates to the Hospice Quality Reporting Program

In this week’s Monday Minute, we address the latest release to the Hospice Provider Preview Reports of the Hospice Quality Reporting Program. Additionally, we will be discussing the significant 4% payment reduction that will be imposed if the HQRP requirements are not met.

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Reviewing the 2024 Hospice Final Rule

In this week’s Monday Minute, we discuss the 2024 Hospice Final Rule that was released July 2023.

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

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

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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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Reviewing the Implications of the Recent VBID Model Update (VIDEO)

In this week’s Monday Minute, we discuss the recent update to the Value-Based Insurance Design (VBID) model, which includes the Hospice benefit.

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First Look at Updated Hospice PEPPER Reports and Proposed Rule 2024 (VIDEO)

In this week’s Monday Minute, we discuss the recent updates in the Hospice PEPPER Reports and take a look at the Proposed Rule 2024.

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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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Hospice Self-Reported Aggregate Cap Due by February 28 (VIDEO)

This week’s Monday Minute, we discuss time-sensitive information regarding the Hospice Aggregate Cap.

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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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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.

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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.

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Impact of December 2022 CAHPS Hospice Survey Update (VIDEO)

In this week’s Monday Minute, we talk about the December 2022 CAHPS Hospice Survey update.

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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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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.

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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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2023 Hospice Final Payment Rule (VIDEO)

This session will review the key highlights from the 2023 Hospice Final Rule. Payment rates have increased, the Hospice Cap is set and the HOPE is looking for Beta testers. Don’t miss it!

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Clarification on Hospice Transfers (VIDEO)

This Minute will review the clarification that CMS is providing regarding the fact that Hospice transfers cannot have a break in days in billing.

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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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2023 Hospice Proposed Rule Recap (VIDEO)

This Monday Minute will begin unfolding the important content of the Hospice Proposed Rule for 2023.

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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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OIG Report Released Regarding NonHospice Payments While Patients are on Hospice Services (VIDEO)

This Monday Minute will review the OIG Report and what it possibly means for the future of Hospice Medical Review Audits & Investigations.

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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.

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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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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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Compliance with the Hospice Quality Reporting Program (HQRP) (VIDEO)

This Monday Minute reviews the two components of the HQRP that impact the hospice reimbursement, if noncompliant.

There are two portions to the Hospice Quality Reporting Program. One is related to the CAHPS Hospice Survey participation, and the other is related to the HIS transmission requirement and today we will look into both.

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VBID Awareness as Hospice enters 2022 (VIDEO)

This Monday Minute will touch some very key points for Hospices in regard to the VBID demonstration.

The VBID demonstration started, of course in 2021, and will continue in 2022 into phase two. With 2022 beginning there are going to be several Medicare Advantage Plans added to the VBID model.

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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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Home Health & Hospice Quality Reporting Programs (VIDEO)

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

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Value-Based Insurance Design (VBID) Model: Hospice and Medicare Advantage in 2022 (VIDEO)

This Monday Minute will take you through a brief update on the 2022 VBID model, which includes Hospice in the Medicare Advantage Organization plans that have volunteered to participate in the VBID demonstration.

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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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Local Coverage Determinations (LCD) (VIDEO)

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

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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.

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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.

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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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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.

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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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2022 Hospice Final Rule Released (VIDEO)

This minute covers a quick recap of The Hospice Final Rule released on July 29, 2021 that updates Medicare hospice payments and the aggregate cap amount for FY 2022 in accordance with existing statutory and regulatory requirements. Make sure to stay tuned for more updates!

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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!

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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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Hospice Proposed Rule Comments & Happy Nurse’s Month! (VIDEO)

Welcome to Monday Minute with Melinda! This Minute highlights some very key components of the Hospice Proposed Rule that needs your feedback. 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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FY2022 Hospice Proposed Payment Rule

In addition to the proposed changes for hospice providers CMS included proposed changes to the Home Health Quality Reporting program (HH QRP) to resume in the reporting for January 2022. The proposed rule for hospice and home health QRP is summarized in today’s blog.

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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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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!

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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!

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Value-Based Insurance Design (VBID) Model: Medicare Advantage – Hospice Carve-in

Medicare Advantage Value-Based Insurance Design (VBID) Model was developed for CMS to test a broad array of Medicare Advantage (MA) health plan innovations designed to reduce Medicare program expenditures, enhance the quality of care for Medicare beneficiaries, and improve the coordination and efficiency of health care service delivery. The goal is for the VBID Model to contribute to the modernization of MA and test whether these model components improve health outcomes and lower expenditures for MA enrollees.

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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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Hospice ADRs on the Rise! (VIDEO)

Welcome to Monday Minute with Melinda! This week’s video clip will provide some key elements of responding to Hospice ADRs. Monday Minute with Melinda gives agencies the opportunity to receive critical weekly video updates, Make sure to stay tuned!

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Implementation of Home Infusion Therapy services

The Home Infusion Therapy (HIT) benefit went into effect January 1, 2021. HIT services are excluded from coverage under the Medicare Home Health Benefit. If an agency has a home infusion pharmacy that is an accredited home infusion therapy supplier as well, they can now bill this service portion through the Part B benefit.

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Implementation of Hospice Item Set (HIS) V3.00 & Hospice Quality Reporting Program (HQRP) Reporting Reminders

The Hospice Quality Reporting Program (HQRP) webpage released an Important Update on 12/31/20 regarding the implementation of the Hospice Item Set (HIS) version V3.00 specifications. The Update stated that on January 1, 2021, CMS will move forward with the implementation of V3.00 of the HIS data submission specifications.

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2021 Hospice Final Payment Rule

The Hospice FY2021 Final Wage Index and Payment Rate Update from CMS is summarized in this post with changes for Hospice providers. The new regulations will be effective on October 1, 2020. The overall economic impact of this final rule is estimated to be $540 million in increased payments to hospices for FY2021. HPS is working to keep Hospices informed of all the details related to the changes with the 2021 Final Rule.

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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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Hospice Targeted Probe and Educate – Avoid Claim Denials

Targeted Probe and Educate (TPE) is continuing to be a problem for Hospice providers with some advancing to rounds 2 and 3 of the audit. This demonstration, which includes hospices receiving 20-40 claim requests for Additional Development Requests (ADR) in each round, have hospices wondering if they are going to be targeted next. In order to avoid advancing to the next round of TPE, the hospice’s calculated error percentage at the end of each round must be less than the percentage set by the MAC.

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Documenting Hospice Eligibility for a Cardiopulmonary Diagnosis

When documenting hospice eligibility for a cardiopulmonary diagnosis you MUST go beyond the disease-specific LCD guidelines to avoid denial under medical review.  Many people who suffer from advanced cardiopulmonary disease share multiple symptoms as the disease progresses, however, the symptoms affect each patient differently and therefore, must be documented this way in order to support each patient’s terminal condition.

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FY2020 Hospice Final Rule: Changes to Hospice Reimbursement

The rule rebases the continuous home care, general inpatient care and the inpatient respite care per diem payment rates in a budget-neutral manner to more accurately align Medicare payments with the cost of providing care. In addition, the rule modifies the election statement by requiring an addendum that includes information aimed at increasing coverage transparency for patients under a hospice election. Finally, this rule includes changes to the Hospice Quality Reporting Program.

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Targeted Probe & Educate (TPE): Top 5 Hospice Denial Reasons

As long as hospices are carefully documenting the details of each patient’s clinical situation and each patient meets the eligibility requirements for hospice care—these denials are avoidable. Don’t be the hospice that gets technical denials for careless mistakes, like incorrect format of the election statement or completing CTIs with boxed/canned statements that are not specific to the patient.

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8 Major Changes Outlined in the FY2020 Hospice Wage Index Update

The FY2020 Hospice Wage Index & Payment Rate Update & HQRP Proposed Rule presents significant changes to rates and election statements. This proposed rule needs our full attention and comments! Please do your part and comment by the deadline stated in this article.

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Documenting Hospice Eligibility for Alzheimer’s Dementia

When admitting a patient to hospice with a primary terminal diagnosis of Alzheimer’s disease, your documentation should clearly show the nature and condition causing the hospice admission in addition to, the hospice disease-specific LCD guidelines.

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Required Hospice GIP Documentation

General Inpatient (GIP) Care is one of the four levels of care available to patients who elect the Medicare Hospice Benefit. When may GIP level of care be appropriate? When is it NOT appropriate to use GIP level of care?

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Hospice Item Added to OIG Work Plan – Protecting Medicare Hospice Beneficiaries from Harm

The OIG released a hospice portfolio report Vulnerabilities in the Medicare Hospice Program Affect Quality Care and Program Integrity in July of 2018, identifying vulnerabilities in the Medicare Hospice Program and made 16 recommendations to CMS to strengthen the hospice program.

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Top Denial Reasons – Hospice Targeted Probe and Educate

Targeted Probe and Educate (TPE) is underway for Hospice Agencies. HPS is seeing many ADR denials with agencies moving to round 2 and 3 of TPE from both CGS and NGS.

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Hospice HEART Update

The retooling of the Hospice Evaluation and Assessment Reporting Tool (HEART) is a significant development. CMS has been moving rather expeditiously on the HEART tool, and it is believed the tool is one of the key components necessary for future changes in hospice including payment refinement.

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Big Changes for Hospice Billing – MLN Matters SE18007

CMS recently released MLN Matters SE18007 which details recent and upcoming improvements to Medicare hospice billing. Two recent improvements – Electronic Submission of the Notice of Election (NOE) and Correcting Election or Revocation Dates using Occurrence Code 56 – are summarized and additional upcoming improvements are addressed.

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Hospice Utilization & Payment Public Use File

CMS is proposing to add Hospice Utilization and Payment Public Use File (Hospice PUF) data to Hospice Compare. The PUF data is derived primarily from hospice claims and the most current PUF data is from FY2015. The data would be in a segregated section of Compare as it contains information about hospice payments and utilization not quality measures.

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Hospice FY2019 Proposed Rule – Payment and Quality Reporting Program

The FY 2019 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements proposed rule was recently made available. Of concern is the fact that CMS found 66% of hospice cost reports would have been rejected had certain edits been in place. Check back soon for future blog articles containing more detailed information about the quality reporting program updates and comments in the proposed rule.

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Hospice Quality Measure Reports Available

The Centers for Medicare and Medicaid Services (CMS) recently announced that corrections have been made to the hospice quality measure reports available in CASPER and are now ready for viewing. It has come to our attention that some hospices are not aware of these reports and are not accessing them and are missing out on valuable information. To get started with CASPER…

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Hospice 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 Hospice.

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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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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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Preparing for Hospice Targeted Probe and Educate (TPE)

As previously reported, the targeted probe and educate (TPE) process is replacing the medical review process used by Medicare Administrative Contractors (MAC).  Each of the three MACs – Palmetto GBA, NGS and CGS – can choose the topics for review under TPE based on existing data analysis procedures.

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Hospice CTI and Election Statement Made Easy

CMS reminded hospices recently about the need to comply with Medicare hospice election statements and certification of terminal illness (CTI) requirements. This reminder comes shortly after CMS’ announcement of the expansion of the targeted probe and educate (TPE) method of medical review to hospices and other provider types. We believe there is a strong possibility that CMS will…

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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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Corrections to SIA & RHC Made Easy

CMS announced this week that Medicare Administrative Contractors (MAC) will accept a list of claims to be adjusted for incorrect service intensity add-on (SIA) and incorrect routine home care (RHC) payments, where the error is not related to hospice beneficiary transfers. The SIA and high/low RHC payment changes were…

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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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Hospice General Inpatient Care

CMS continues to be concerned about hospice over utilization and hospice underutilization of the general inpatient (GIP) level of care. Are hospices providing access to all four levels of hospice care (routine home care, general inpatient care, respite care and continuous home care)?

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2018 Hospice Final Rule & NOE Electronic Submission

Late Tuesday, August 1, 2017 the final hospice rule – FY 2018 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements – was posted. The rule contains the FY2018 finalized payment rates, aggregate cap, and hospice quality reporting changes. On July 27, 2017 CMS released Transmittal 3813/Change Request (CR) 10064 – Accepting Hospice Notices of Election via Electronic Data Interchange. Hospices will be happy to hear…

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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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Hospice Proposed Rule

In addition to the proposed changes for hospice providers CMS included proposed changes to the Home Health Quality Reporting program (HH QRP) to resume in the reporting for January 2022. The proposed rule for hospice and home health QRP is summarized in today’s blog.

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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.

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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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Hospice Regulatory Update

Over the last few weeks there have been updates that hospice should be aware of:  the 2017 Final Rule has been issued and Medicare MACs have finally acknowledged that the…

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Key Points Regarding 2016 Hospice Payment Reform

The two most significant changes associated with 2016 Hospice Payment Reform are the High vs. Low rates for Routine Home Care (RHC) level of care days and the Service Intensity Add-On…

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Hospice CAHPS Surveys Will Affect Payment

The regulatory issues just keep mounting with both home health and hospice. This information is technically not new, but needs to be reiterated for hospices that may not be as…

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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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New G-Codes Not JUST for HOSPICE!

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

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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…

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The Y2K of Coding!

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

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Finally Some Relief or Not!

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

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Home Care and Hospice: Still No Relief!

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

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CMS Issues 2016 FINAL Hospice Payment and Quality Rule

The FINAL Hospice Payment Rule was released on July 31, 2015 and addresses payment reform of the routine home care (RHC) level of care by providing a payment of two…

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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…

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Hospice Medicaid Room and Board Billing Tips

State Medicaid programs will reimburse hospice agencies 95% of the room and board costs they incur for treating eligible Medicaid patients in nursing facilities. It would be simple if the…

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CMS Issues FY2016 Proposed Hospice Payment and Quality Rule

The PROPOSED Hospice Payment Rule was released on April 30, 2015 and addresses payment reform of the routine home care (RHC) level of care by providing a payment of two…

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Hospice Untimely NOE and CAP Self Reporting

HOSPICE UNTIMELY NOE With the new timely filing deadline for the filing and acceptance of the Notice of Election (NOE) documents there are reimbursement issues that occur when those timely…

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