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NAHC Submits Comments to CMS on Proposed Home Health Cost Report Changes

The National Association for Home Care & Hospice (NAHC) and the Home Health Financial Managers Association (HHFMA) submitted comments on the Centers for Medicare & Medicaid Services (CMS) proposed changes to the home health cost report (Form CMS-1728-19) and cost reporting instructions. On April 16, 2019, the CMS published notice in the Federal Register of plans to revise the

How will the EMPOWER Care Act affect HHAs?

The Empower Care Act (Ensuring Medicaid Provides Opportunities for Widespread Equity, Resources, and Care) was re-introduced to the senate early in 2019. This bill is intended to expand as well as renew/reauthorize funding and participation in the transitioning of Medicaid beneficiaries from hospital or institutional settings to home and community-based services under the Money Follows

Program for Evaluating Payment Patterns Electronic Report

New Home Health Agency PEPPER Available The Q4CY18 release of the Home Health Agency (HHA) Program for Evaluating Payment Patterns Electronic Report (PEPPER) with statistics through December 2018 is now available for download through the PEPPER Resources Portal. To obtain your agency’s PEPPER, the Chief Executive Officer, President, Administrator or Compliance Officer should: Review the

July 2019, Quarterly Release Temporary Hold

Each quarter, the Fiscal Intermediary Shared System (FISS) is updated to include new logic for claims processing, pricing, etc. When the release is installed, Palmetto GBA places a temporary “hold” to ensure the release is installed properly. During this time, claims with dates on service of July 1, 2019, or later will be held in

What Physicians should know about Value-Based Payment Models

Payment models have undergone numerous and frustrating changes over the past few years, and the implementation of the value-based reimbursement model is no exception. Physicians submitting claims to Medicare have likely experienced the changes relating to this payment model. Value-based reimbursements are/were intended to compensate providers based on performance and guidelines focused on improving patient

CMS Announces Further Changes to Support Hospice Eligibility Inquiries in HETS

Over recent years the Centers for Medicare & Medicaid Services (CMS) has sought to streamline hospice beneficiary eligibility inquiries and establish the HIPAA Eligibility Transaction System (HETS) as the single source for this data. This effort was delayed due in part to the availability of insufficient information in the HETS system regarding hospice benefit period

CMS Releases Additional Instructions for Claims under PDGM

The Centers for Medicare & Medicaid Services (CMS) has released a second set of revisions to Chapter 10 of the Medicare Claims Processing Manual providing instructions to home health agencies for claims submission under PDGM. CMS Transmittal 4294/Change Request (CR) 11272, Home Health (HH) Patient-Driven Groupings Model (PDGM) – Additional Manual Instructions, provides some clarity

Renewal of the HHCCN

The Office of Management and Budget (OMB) has approved the Home Health Change of Care (HHCCN) Form, CMS-10280.  Effective July 1, 2019, all Home Health Agencies (HHA) will be required to use the renewed form with the expiration date of 4/30/2022 on the bottom.  Please note that HHAs may continue to use the old form

Information About Home Health Ordering/Referring/Attending Physician Adjustments

From October 1, 2018, through April 22, 2019, the home health ordering/referring/attending physician reason code 32072 was not editing correctly. This allowed claims containing a terminated attending physician to incorrectly pay. These claims should have denied. In the beginning of May, a Fiscal Intermediary Shared System (FISS) utility was initiated to adjust claims that should

Billing Process Tips that Increase Revenue

Treating patients is your job. So too is getting paid. Unless you belong to a large medical group, chances are that your staff is taking care of billing for you. Small practices are especially at risk of delayed payments for a variety of reasons. Approximately 83% of physician practices with fewer than five practitioner states