Special Alert for All Home Health Operators from NAHC!

Reposted from an email alert sent to IAHHC members:

January 9, 2019 Special Alert for All Home Health Operators!

An extremely serious issue involving Medicare home health has surfaced that requires the immediate attention of your organization.

Effective January 13, 2018, the “Plan of Care” (POC) Condition of Participation under 42 CFR 484.60 also became a Condition for Payment under the home health benefit, 42 CFR 409.43. This means that all the elements must be in the POC or Medicare payment will be denied. While this generally does not present any concerns, one of the new POC requirements has created problems for many HHA s that may not have modified their POCs sufficiently to meet the new POC requirements. A compliant POC for payment purposes must now include “information related to any advance directives.”Recent audits as part of the Comprehensive Error Rate Testing (CERT) program have uncovered significant noncompliance with this new requirement.  At the same time, MAC audits have approved claims that involve POCs that do not include full information on a patient’s advance directives.NAHC is advocating to CMS that a broad-scale, efficient remedy needs to be implemented given the apparent widespread oversight by HHAs. These HHAs do appear to have obtained all the needed advance directive information. It is just that the information did not fully find its way to the POC. At this point, CMS has not agreed to any remedial measures other than potentially hundreds of thousands of individual claim corrections.In the absence of a systemic fix, the noncompliance puts HHAs at risk of further audits and the likelihood of a high volume of retroactive claim denials. However, there is still an opportunity to correct these POC deficiencies. Still, that opportunity will be shrinking as claim corrections must be filed prior to the close of the one year window for claim submissions that will begin to close on January 13, 2019.

Review January 13, 2018, and later POCs to determine if they are compliant. For example, a POC will not be compliant on the Advance Directives requirement if the only entry references whether or not the patient has a Do Not Resuscitate (DNR) order as there are more types of Advance Directives than just DNRs.If you find non-compliance, review the patient record to determine if the needed information is available. For example, the OASIS info should include Advance Directive detail. For non-compliant claims, secure a signed POC addendum from the certifying physician that includes the required information for the POC. Submit corrected claims to your MAC. One of the MACs is accepting these corrections without a need to cancel the original claim and submitting a rebilling as there is no reimbursement effect. We expect the other MACs will do the same. The corrected submissions can be done sequentially over the next twelve months so that the administrative burden is spread out consistent with the one-year window on claim submissions. It is advisable to get your MACs take on how to handle corrections before proceeding. The correction process is a huge burden for HHAs, physicians, and Medicare itself. Since there is no effect on payment rates, NAHC strongly believes that it is in everyone’s interest that sensible remedial actions take place instead of massive claim corrections. Nevertheless, HHAs must protect themselves from the risk of retroactive claim denials based on insufficient advance directives information on the POC before corrective opportunities close with the one-year window. At present, the burdensome approach outlined above is the only option. For further information, contact Mary Carr mkc@nahc.org, or Katie Wehri, Katie@nahc.org at NAHC.

Posted in NAHC ReportTagged advanced directivesCMSComprehensive Error Rate Testinghome healthMedicareMedicare Administrative Contractorsplan of care

CMS Rule Making Process Begins for OASIS D Item Set

IAHHC sent out the following information concerning the OASIS-D data set process:

CMS filed a notice and request for comment on proposed revisions to the OASIS item set. The notice was posted on the Federal Register website March 9 and is scheduled for publication March 12.

CMS is seeking approval from the Office of Management and Budget for January 1, 2019 implementation of OASIS-D. Public comment will be open for 60 days.

CMS has also posted a 2019 OASIS change table online. In the crosswalk, you will see items that are replacing current items as well new items to be added, such as J1900 (Number of Falls since SOC/ROC, whichever is more recent).

The current version of the item set, OASIS-C2, went into effect just last year. The proposed modifications are driven by the IMPACT Act.

A draft of OASIS-D is expected in July and a finalized version is expected as early as November, CMS officials said during the Q&A portion of a February home health, hospice and durable medical equipment (DME) open door forum.

Related link: View the change table here: http://go.cms.gov/2FGdJsL.

CoP implementation date pushed to 1/13/18

On 07/07/2017 William A.Dombi, Esq. VP for Law with the National Association of Home Care and Hospice (NAHC) shared that CMS just issued the Final Rule setting out an new effective date for CoP compliance.https://s3.amazonaws.com/public-inspection.federalregister.gov/2017-14347.pdf

As proposed, the new compliance deadline is 1/13/18. CMS was not swayed by the recommendations to delay the effective date in line with the issuance of the interpretive guidelines. CMS anticipates an issuance of draft guidelines this Fall with finalization in December. CMS expressed that the regulations can be implemented without the guidelines.[more]

Home Health New CoPs Status


Home Health New CoPs Status

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The latest information from The National Association of Home Care and Hospice (NAHC) on June 30, 2017 is that CMS has informed NAHC that the final rule that will delay the CoPs is at OMB for clearance. For some reason though, it has yet to post to the OMB website. Still, NAHC fully expects the final rule to be issued prior to July 13.

While we do not know the outcome of the final rule, there has been no indication that the delay will be shorter than the proposed January 13, 2018. NAHC recommended that the delay be extended until 6 months following the yet to be released interpretive guidelines.

IAHHC will be diligently watching for the CoP rule and will inform our members promptly.

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Indiana Association for Home & Hospice Care, Inc.
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Source: Home Health New CoPs Status