As you likely know, CMS has released the Final Rule for 2011 and it contained some significant changes for the home care industry in the upcoming year. You may have questions or concerns about what these changes may mean to you. This is the handout from the free webinar presented Dec. 7, 2010.
Managing Resources and Length of Stay: The New CMS Efficiency MeasureAudioEducator
Live Audio Conference on Managing Resources and Length of Stay: The New CMS Efficiency Measure by Toni Cesta - Identify strategies for managing your cost per case.
Urological Non Surgical Hospital Coding for 2014 AudioEducator
This document discusses coding for non-surgical urological hospital services. It notes that the concept of new or established patient does not apply, and that admission, consultative, subsequent visit, shared/split, and discharge services all have specific codes. It reviews codes for initial hospital visits (99221-99223), subsequent visits (99231-99233), and consultations (99231-99232 in place of 99251-99252, and without transfer of care requirements). The document provides an overview of special coding rules and scenarios for non-surgical urological hospital admissions and visits.
Until The Hospice Crystal Ball for 6 Month Prognosis Is Invented, You Have To...AudioEducator
Audio conference on Until The Crystal Ball For 6 Month Prognosis Is Invented, You Have To Document Eligibility by Charlene Ross ? Review the Medicare regulations related eligibility and use of the Local Coverage Determinations (LCD)s.
2011 CMS Physician Quality Reporting System (PQRS): Teaching Doctors of Chiropractic How to Report on Measures Related to Quality Patient Care by Tony Hamm, American Chiropractic Association
The document provides details about the Medicare and Medicaid EHR Incentive Program for eligible professionals. It covers who is eligible to participate, including specific provider types for each program. It discusses the incentive payment amounts for both programs over multiple years. It also outlines the meaningful use requirements including objectives and clinical quality measures that must be met to receive incentive payments.
The document discusses 4 dangerous trends facing medical groups: 1) Regulatory and compliance burdens continue to increase with many new regulations and compliance dates in 2015. 2) Operating costs continue to rise significantly each year, especially for staffing which accounts for over half of practice costs. 3) Provider reimbursement is declining from both government and commercial payers, with Medicare payments being cut and penalties increasing. 4) Patient collections have become critical with declining reimbursement. The presentation provides strategies for practices to address these challenges through improving productivity, evaluating costs, and protecting staff.
Managing Resources and Length of Stay: The New CMS Efficiency MeasureAudioEducator
Live Audio Conference on Managing Resources and Length of Stay: The New CMS Efficiency Measure by Toni Cesta - Identify strategies for managing your cost per case.
Urological Non Surgical Hospital Coding for 2014 AudioEducator
This document discusses coding for non-surgical urological hospital services. It notes that the concept of new or established patient does not apply, and that admission, consultative, subsequent visit, shared/split, and discharge services all have specific codes. It reviews codes for initial hospital visits (99221-99223), subsequent visits (99231-99233), and consultations (99231-99232 in place of 99251-99252, and without transfer of care requirements). The document provides an overview of special coding rules and scenarios for non-surgical urological hospital admissions and visits.
Until The Hospice Crystal Ball for 6 Month Prognosis Is Invented, You Have To...AudioEducator
Audio conference on Until The Crystal Ball For 6 Month Prognosis Is Invented, You Have To Document Eligibility by Charlene Ross ? Review the Medicare regulations related eligibility and use of the Local Coverage Determinations (LCD)s.
2011 CMS Physician Quality Reporting System (PQRS): Teaching Doctors of Chiropractic How to Report on Measures Related to Quality Patient Care by Tony Hamm, American Chiropractic Association
The document provides details about the Medicare and Medicaid EHR Incentive Program for eligible professionals. It covers who is eligible to participate, including specific provider types for each program. It discusses the incentive payment amounts for both programs over multiple years. It also outlines the meaningful use requirements including objectives and clinical quality measures that must be met to receive incentive payments.
The document discusses 4 dangerous trends facing medical groups: 1) Regulatory and compliance burdens continue to increase with many new regulations and compliance dates in 2015. 2) Operating costs continue to rise significantly each year, especially for staffing which accounts for over half of practice costs. 3) Provider reimbursement is declining from both government and commercial payers, with Medicare payments being cut and penalties increasing. 4) Patient collections have become critical with declining reimbursement. The presentation provides strategies for practices to address these challenges through improving productivity, evaluating costs, and protecting staff.
The document provides information on the Medicare and Medicaid EHR incentive programs established under the HITECH Act to promote the meaningful use of electronic health records (EHRs) by eligible providers. It outlines the core and menu requirements to achieve meaningful use certification, associated incentive payment amounts for both programs from 2011-2021, and penalties for providers who do not successfully demonstrate meaningful use. The stages of meaningful use are also summarized, including the objectives and measures for Stage 1 which focus on data capture, tracking clinical conditions, and reporting clinical quality measures.
This document summarizes key points from a presentation by Ben Quirk on various healthcare industry topics. It discusses ICD-10 codes and the delayed implementation date of October 2015. It also covers challenges from sequestration, the Affordable Care Act, and meaningful use requirements, and provides strategies for practices to address reimbursement issues and protect their bottom lines in the changing healthcare environment.
An update for employees and leaders that describes progress towards 2014 goals at the half-year mark. Discussion about Kindred's new Contact Center is included.
The document discusses electronic health records (EHR) and the financial incentives provided by the HITECH Act to encourage physicians and hospitals to adopt EHR systems and achieve meaningful use. It outlines the purpose of the incentives, who is eligible, what meaningful use entails, how much payments are and how to qualify. It also addresses frequently asked questions about EHR incentives and requirements.
Scribes in Primary Care - Inspiring MDs ProductivityErvin Gruia
The document discusses using medical scribes in primary care to improve physician performance and satisfaction. It summarizes a case study that found a significant increase in physician satisfaction, more complete charts, improved clinic revenue and net income, and increased visits per hour when scribes were used. While there was some effort to coordinate staffing, physicians left an average of 1 hour and 41 minutes earlier each day. Proven models are presented that project increased revenue per provider of $1,563.84 per day and decreased time in the office by 41 minutes when scribes are used effectively. Key factors for maximizing the successful use of scribes include adapting workflows, maintaining or increasing patient volumes and appointments, and addressing barriers to change like old behaviors and
The document provides an agenda and information about an upcoming Meaningful Use Mini-Camp on October 21, 2015. The agenda includes introductions, an overview of the California Technical Assistance Program (CTAP), a review of the 2015-2017 Modification Final Rule, a discussion of challenging measures, and strategic planning for Meaningful Use. Additional details are then provided about CTAP funding, milestones, and payments. The document concludes with sections on enrollment in CTAP and an overview of some of the most challenging Meaningful Use measures.
This document provides an overview and update on meaningful use requirements and timelines. It discusses certification, reporting requirements, use of personal health records, and the goals of improving information access and patient empowerment through standards and interoperability. Key points include increasing performance measure thresholds over multiple stages, requirements to exchange data with personal health records and health information exchanges by certain deadlines, and resources to help providers meet meaningful use.
Case study IV hospital - Profitability AnalysisRohit Pinto
The 100-bed hospital had been losing money for two years due to a lack of financial analysis, high overheads, and inefficient processes. A review identified unprofitable services, excessive staffing, and process issues. Recommendations included rightsizing staff, increasing prices for undervalued services, bundling operating charges, and automating cash handling. Within a year, the changes generated over 70 lakh in additional profits annually and improved patient volumes, trust and decision making.
Streamlining Your Medical Practice for Profitability and SuccessConventus
Conventus webinar video providing key success strategies and tactics for improving productivity, profitability, and patient care. The one-hour video features host Susan Lieberman of Conventus and Stevie Davidson of Health Informatics Consulting.
Physician Quality Reporting System (PQRS) is a CMS reporting program that uses a combination of incentive payments and penalties to promote reporting of quality data. This presentation discusses.
Meaningful Use and Electronic Health Records: What You Need to KnowQualifacts
The document discusses meaningful use and electronic health records (EHRs). It explains that meaningful use aims to improve health outcomes, quality, and costs through certified EHR use. It outlines the Medicare and Medicaid EHR incentive programs and payment amounts eligible professionals can receive for meeting meaningful use criteria over multiple years. The document also discusses patient volume requirements, exclusions, calculations, and how groups can qualify. It provides an overview of stage 1 meaningful use measures and certification levels for EHRs.
Fy 2021 hrsa operational site visit updates 2021.09.08Compliatric
On May 27 2021, HRSA updated the Site Visit Protocol to further align with the Health Center Program Compliance Manual. While a high level overview of the changes was presented in a previous webinar on June 8th, this session will allow participants to further explore specific updates to assist with continuous compliance. Participants will learn about “Hot Spots” that can affect compliance within the fiscal, clinical and Admin/Governance sections. Best practices will be shared and presenters will allow additional time for questions.
Please join us on September 8th for this exciting webinar hosted by Michelle Layton and Jennifer Genua-McDaniel.
This document provides an agenda and overview for a webinar on updates to the Health Resources and Services Administration's (HRSA) Operational Site Visit protocol. The webinar will focus on "hot spots" or key areas of the protocol that have been updated, including changes to requirements for needs assessments, required and additional health services, clinical staffing, and sliding fee discount programs. Attendees will have an opportunity to ask questions and receive tips from reviewers on preparing for a site visit. Previous webinars focused on maintaining continuous compliance with the HRSA Compliance Manual and a deep dive on site visit protocol updates.
This document discusses an integrated wellness solution that identifies risks, plans incentives, and measures outcomes. It analyzes data to identify cost drivers and provide money-saving solutions. The solution assists with establishing wellness programs that incentivize participation and health improvements through premium adjustments. It provides services like biometric screenings, online tools, and support with appeals and regulations to implement effective wellness programs.
The document provides guidance on the 2007 Physician Quality Reporting Initiative (PQRI) for eligible medical professionals. It describes the goals of the PQRI to focus on quality of care and reward reporting of quality measures with financial incentives. It outlines the eligible professionals, quality measures, reporting requirements, and bonus payments for successful reporting. It also provides details on understanding the quality measures, applicable codes, modifiers, and examples of successful reporting.
The document discusses performance evaluation in healthcare. It defines performance evaluation as measuring organizational performance to improve quality of care. Hospitals evaluate performance to plan improvements, ensure efficient resource use, and assess health programs. Evaluation methods include regulatory inspections, consumer surveys, third-party assessments, statistical indicators, and internal assessments. Key performance indicators help facilities compare performance and identify areas for increased patient satisfaction and operational efficiency. The presentation provides examples of operational, financial, internal, public health, and quality of care metrics that are important for performance evaluation.
The document provides information about the 2007 Physician Quality Reporting Initiative (PQRI) including eligible professionals, quality measures, reporting requirements, bonus payments, validation, and considerations for 2008. Eligible professionals can earn a 1.5% bonus payment by reporting certain quality measures to the Centers for Medicare and Medicaid Services between July and December 2007.
This document provides strategies for physicians to successfully participate in the 2007 Physician Quality Reporting Initiative (PQRI) program, which provides bonus payments for reporting on quality of care measures. It discusses selecting quality measures, defining team roles, modifying workflows to capture quality data, reporting the data using claims codes, and understanding how satisfactory reporting and bonus payments will be determined. The goal is to help integrate quality data reporting into clinical practices to improve care and prepare for future pay-for-performance programs.
The document provides information on the Medicare and Medicaid EHR incentive programs established under the HITECH Act to promote the meaningful use of electronic health records (EHRs) by eligible providers. It outlines the core and menu requirements to achieve meaningful use certification, associated incentive payment amounts for both programs from 2011-2021, and penalties for providers who do not successfully demonstrate meaningful use. The stages of meaningful use are also summarized, including the objectives and measures for Stage 1 which focus on data capture, tracking clinical conditions, and reporting clinical quality measures.
This document summarizes key points from a presentation by Ben Quirk on various healthcare industry topics. It discusses ICD-10 codes and the delayed implementation date of October 2015. It also covers challenges from sequestration, the Affordable Care Act, and meaningful use requirements, and provides strategies for practices to address reimbursement issues and protect their bottom lines in the changing healthcare environment.
An update for employees and leaders that describes progress towards 2014 goals at the half-year mark. Discussion about Kindred's new Contact Center is included.
The document discusses electronic health records (EHR) and the financial incentives provided by the HITECH Act to encourage physicians and hospitals to adopt EHR systems and achieve meaningful use. It outlines the purpose of the incentives, who is eligible, what meaningful use entails, how much payments are and how to qualify. It also addresses frequently asked questions about EHR incentives and requirements.
Scribes in Primary Care - Inspiring MDs ProductivityErvin Gruia
The document discusses using medical scribes in primary care to improve physician performance and satisfaction. It summarizes a case study that found a significant increase in physician satisfaction, more complete charts, improved clinic revenue and net income, and increased visits per hour when scribes were used. While there was some effort to coordinate staffing, physicians left an average of 1 hour and 41 minutes earlier each day. Proven models are presented that project increased revenue per provider of $1,563.84 per day and decreased time in the office by 41 minutes when scribes are used effectively. Key factors for maximizing the successful use of scribes include adapting workflows, maintaining or increasing patient volumes and appointments, and addressing barriers to change like old behaviors and
The document provides an agenda and information about an upcoming Meaningful Use Mini-Camp on October 21, 2015. The agenda includes introductions, an overview of the California Technical Assistance Program (CTAP), a review of the 2015-2017 Modification Final Rule, a discussion of challenging measures, and strategic planning for Meaningful Use. Additional details are then provided about CTAP funding, milestones, and payments. The document concludes with sections on enrollment in CTAP and an overview of some of the most challenging Meaningful Use measures.
This document provides an overview and update on meaningful use requirements and timelines. It discusses certification, reporting requirements, use of personal health records, and the goals of improving information access and patient empowerment through standards and interoperability. Key points include increasing performance measure thresholds over multiple stages, requirements to exchange data with personal health records and health information exchanges by certain deadlines, and resources to help providers meet meaningful use.
Case study IV hospital - Profitability AnalysisRohit Pinto
The 100-bed hospital had been losing money for two years due to a lack of financial analysis, high overheads, and inefficient processes. A review identified unprofitable services, excessive staffing, and process issues. Recommendations included rightsizing staff, increasing prices for undervalued services, bundling operating charges, and automating cash handling. Within a year, the changes generated over 70 lakh in additional profits annually and improved patient volumes, trust and decision making.
Streamlining Your Medical Practice for Profitability and SuccessConventus
Conventus webinar video providing key success strategies and tactics for improving productivity, profitability, and patient care. The one-hour video features host Susan Lieberman of Conventus and Stevie Davidson of Health Informatics Consulting.
Physician Quality Reporting System (PQRS) is a CMS reporting program that uses a combination of incentive payments and penalties to promote reporting of quality data. This presentation discusses.
Meaningful Use and Electronic Health Records: What You Need to KnowQualifacts
The document discusses meaningful use and electronic health records (EHRs). It explains that meaningful use aims to improve health outcomes, quality, and costs through certified EHR use. It outlines the Medicare and Medicaid EHR incentive programs and payment amounts eligible professionals can receive for meeting meaningful use criteria over multiple years. The document also discusses patient volume requirements, exclusions, calculations, and how groups can qualify. It provides an overview of stage 1 meaningful use measures and certification levels for EHRs.
Fy 2021 hrsa operational site visit updates 2021.09.08Compliatric
On May 27 2021, HRSA updated the Site Visit Protocol to further align with the Health Center Program Compliance Manual. While a high level overview of the changes was presented in a previous webinar on June 8th, this session will allow participants to further explore specific updates to assist with continuous compliance. Participants will learn about “Hot Spots” that can affect compliance within the fiscal, clinical and Admin/Governance sections. Best practices will be shared and presenters will allow additional time for questions.
Please join us on September 8th for this exciting webinar hosted by Michelle Layton and Jennifer Genua-McDaniel.
This document provides an agenda and overview for a webinar on updates to the Health Resources and Services Administration's (HRSA) Operational Site Visit protocol. The webinar will focus on "hot spots" or key areas of the protocol that have been updated, including changes to requirements for needs assessments, required and additional health services, clinical staffing, and sliding fee discount programs. Attendees will have an opportunity to ask questions and receive tips from reviewers on preparing for a site visit. Previous webinars focused on maintaining continuous compliance with the HRSA Compliance Manual and a deep dive on site visit protocol updates.
This document discusses an integrated wellness solution that identifies risks, plans incentives, and measures outcomes. It analyzes data to identify cost drivers and provide money-saving solutions. The solution assists with establishing wellness programs that incentivize participation and health improvements through premium adjustments. It provides services like biometric screenings, online tools, and support with appeals and regulations to implement effective wellness programs.
The document provides guidance on the 2007 Physician Quality Reporting Initiative (PQRI) for eligible medical professionals. It describes the goals of the PQRI to focus on quality of care and reward reporting of quality measures with financial incentives. It outlines the eligible professionals, quality measures, reporting requirements, and bonus payments for successful reporting. It also provides details on understanding the quality measures, applicable codes, modifiers, and examples of successful reporting.
The document discusses performance evaluation in healthcare. It defines performance evaluation as measuring organizational performance to improve quality of care. Hospitals evaluate performance to plan improvements, ensure efficient resource use, and assess health programs. Evaluation methods include regulatory inspections, consumer surveys, third-party assessments, statistical indicators, and internal assessments. Key performance indicators help facilities compare performance and identify areas for increased patient satisfaction and operational efficiency. The presentation provides examples of operational, financial, internal, public health, and quality of care metrics that are important for performance evaluation.
The document provides information about the 2007 Physician Quality Reporting Initiative (PQRI) including eligible professionals, quality measures, reporting requirements, bonus payments, validation, and considerations for 2008. Eligible professionals can earn a 1.5% bonus payment by reporting certain quality measures to the Centers for Medicare and Medicaid Services between July and December 2007.
This document provides strategies for physicians to successfully participate in the 2007 Physician Quality Reporting Initiative (PQRI) program, which provides bonus payments for reporting on quality of care measures. It discusses selecting quality measures, defining team roles, modifying workflows to capture quality data, reporting the data using claims codes, and understanding how satisfactory reporting and bonus payments will be determined. The goal is to help integrate quality data reporting into clinical practices to improve care and prepare for future pay-for-performance programs.
1. PPS Final Rule 2011:
What will it mean for you?
Presented by:
Cheri Whalen
Vice President of EDI and
Regulatory Compliance
2. HEALTHCAREfirst
The industry's leading provider of Web-based
management software, outsource services and
consultation exclusively for Home Health Care and
Hospice Care agencies.
We work with more than 1,200 agencies as a
trusted partner to deliver leading-edge solutions
that are built around your day-to-day needs at the
point-of-care and beyond.
3. Cheri joined HCF in 2004, bringing over 10 years of prior experience
focused exclusively within the Home Health and Hospice software
industry to our team. Her Home Health and Hospice experience
includes customer service, quality assurance, documentation,
Introduction development of billing and regulatory software design
requirements, HIPAA Compliance Champion and overseeing
Cheri Whalen regulatory compliance for business units, employees, and software
VP of EDI & Compliance products.
Cheri currently assists Home Health and Hospice agencies with
setting up and maintaining regulatory compliance with Medicare,
state auditors and accrediting bodies as well as providing software
design for billing, electronic data interchange and regulatory
compliance.
Cheri also oversees the company’s interests in compliance with the
many federal regulations (including HIPAA and HITECH) and
provides educational opportunities for our customers and our
employees.
Visit my blog at: http://blog.healthcarefirst.com/regulatory-blog/
4. Effective Dates
Changes apply to episodes ending
January 1, 2011
Episodes you currently have in
process will fall under these rules.
5. Case Mix Changes
• Case mix reduction of
3.79% for CY 2011
• CMS has indicated
another 3.79%
reduction for 2012
– Continuing to evaluate
6. CY 2011 Payment Rates
2011 Base Rate Discipline Non – Rural Rural
$2,192.07 HHA $ 50.42 $ 51.93
MSS $ 178.46 $ 183.81
OT $ 122.54 $ 126.22
2011 RURAL Base
PT $ 121.73 $ 125.38
Rate $2,257.83 SN $ 111.32 $ 114.66
SLP $ 132.27 $ 136.24
*note a 2% reduction to
these rates when not
submitting quality data
7. CY 2011 Payment Rates
Non-Routine Supply Severity Level Non – Rural Rural
Rates (NRS) 1 $ 14.18 $ 14.61
2 $ 51.18 $ 52.72
*note a 2% reduction to 3 $ 140.34 $ 144.55
these rates when not 4 $ 208.51 $ 214.77
submitting quality data 5 $ 321.53 $ 331.18
6 $ 553.00 $ 569.59
8. CY 2011 Payment Rates
LUPA Add-On Rates
Non – Rural Rural
$ 93.31 $ 96.11
*note a 2% reduction to these rates
when not submitting quality data
9. Other CY 2011Payment Adjustments
• Outlier
– The 10% agency-level cap was made permanent
• Fixed Dollar Loss
– Remains the same at .67
• Quality Data Submission
– Remains the same at a 2% base-rate reduction for
providers who do not submit their OASIS data.
10. Hypertension
CMS had originally proposed
a change to drop
Hypertension scoring from
the case-mix
Due to comments during the
proposal period, CMS has
left the hypertension scoring
as it is but expect additional
review in this area.
11. Therapy Coverage Requirements
Changes to therapy coverage requirements:
• Assessments must be completed by a qualified therapist
for the service
• Measureable treatment goals in the plan of care &
clinical record
• Assessments must be an objective measurement with a
succession of comparable measurements to show
progress toward the goal or the effectiveness of the
therapy.
• Assessments must measure and document the progress
toward the goal at least once every 30 days during the
course of treatment.
12. Therapy Qualifications
• Patients needing 13 or 19 therapy visits will require the
qualified therapist to perform a visit and assessment to
measure and document the effectiveness of the therapy.
– If progress toward the plan of care goal cannot be measured or
documentation does not support the expectation of reasonable
progress, CMS can discontinue coverage.
– Each therapy discipline required for the patient must be
assessed by the 13th and 19th visits
• Exceptions provided for rural areas or when outside the control of the
therapist (documented)
13. Therapy Qualifications: Maintenance
Maintenance Therapy will be covered when:
– Specific to illness or injury
– Requires the skills of a therapist
– Identifies program design (by qualified therapist),
instruction & re-evaluation
14. Therapy Assessment Implementation
Therapy Assessment changes are effective
1/1/2011; however, CMS has delayed the
implementation to allow for a transition period.
You will have until April 2011 to implement, and
additional guidance will be provided by CMS in
the future.
15. Home Health Compare
Process measures were publically New OASIS-C Outcome measures will
reported Oct 2010. publically reported July 2011
• Timely initiation of care
• Influenza immunization received for current flu • Improvement in ambulation/locomotion
season
• Improvement in bathing
• Pneumococcal polysaccharide vaccine ever received
• Improvement in *bed* transferring
• Heart failure symptoms address during short term
episodes • Improvement in management of oral meds
• Diabetic foot care and patient education • Improvement in pain interfering with activity
implemented during short-term episodes of care • Acute care hospitalizations
• Pain assessment conducted • Emergent care Use *without hospitalization*
• Pain interventions implemented during short-term • Improvement in dyspnea
episodes • Improvement in surgical wounds
• Depression assessment conducted
• Drug education on all medications provided to
patient/caregiver during short-term episodes
• Falls risk assessment for patients 65 and older
• Pressure ulcer prevention plans implemented
• Pressure ulcer risk assessment conducted
• Pressure ulcer prevention included in the plan of
care
16. HH CAHPS Reporting
CMS expects a dry run of 1 Agencies with less than 60
full month of data in the eligible patients (per year)
third quarter of 2010 and new agencies can
reported by your request an exemption
HHCAPHS vendor Dry Run & exemption
Continuous reporting must deadline is January 21,
start 4th quarter 2010 and 2011
1st quarter 2011 Non-participation will result
in a 2% reduction in the
market basket
17. G – Code Description
G0151 Qualified PT
Additional Billing Codes G0152 Qualified OT
G0153 Qualified SLP
CMS is implementing the addition of
new G-code changes for billing to G0157 PTA
further define services provided.
G0158 OTA
G0159 Maintenance Therapy by qualified PT
G0160 Maintenance Therapy by qualified OT
G0161 Maintenance Therapy by qualified SLP
G0154 Skilled licensed Nurse (direct patient care)
G0162 Management & Eval of POC RN
G0163 Observation & Assessment of Patient
Condition LPN or RN
G0164 Skilled licensed Nurse Training/Education of
patient/family
18. • The IROF is a requirement for
HHA Capitalization enrollment
Requirements • Medicare billing privileges
CMS has implemented requirements
will be denied or revoked if
for new HHA’s to not only have their
“initial operating reserve funds” be
the HHA could not provide
available at certification, but have this proof of IROF within 30 days
reserve fund available through the
application process as well as 3
of request
months after billing privileges are
instated. • HHA must have IROF at the
time of application, all times
The contractor will provide the exact
IROF amount to prospective HHA’s. during the enrollment
process, and for 3 months
after billing privileges have
been established.
19. • Medicare Billing privileges
Change of Ownership 36- and certification do not
Month Rule transfer
CMS implemented the “36-month”
• Must reapply to Medicare
rule for changes in ownership of HHA’s
which precluded any HHA to change
and pass certification
hands (100% ownership change)
within 36-months of Medicare
• Applies when >50%
enrollment without having to recertify ownership changes
the agency
– Total for the entire 36-months
During this implementation period
CMS has determined there are certain
– Includes asset sales, stock
instances where a change in transfers, consolidations and
ownership should be allowed without
having to recertify.
mergers
20. 36-month rule Exceptions
• 2 consecutive years of full
cost reports submitted by
the HHA
• Internal restructuring of
the parent company
• Change of business
structure, but owners
remain the same (LLC to
Corporation)
• Owner Dies
21. Change of Ownership
36-Month Rule Implementation
• Applies only to direct
ownership changes
• Applies to nonprofit
agencies as well
• New rules apply to
ownership changes after
Jan 1, 2011
• Existing rules apply
through December 31,
2010
22. Home Health Face-to-Face Encounters
• Physician must have a face-to- • Documentation of the
face encounter within 90 days encounter must be a separate
of the HH SOC or within 30 and distinct section or an
days after the HH SOC addendum to the certification
• Physician must document on – Must include why the clinical
the certification how the findings of the encounter
clinical findings of the support HH Eligibility
encounter support the • Documentation must be dated
eligibility requirements for the
patient to be homebound and
need intermittent skilled nurse
or therapy.
23. Hospice Face-to-Face Encounters
• Hospice physicians or NPs • Encounter must justify why
must make a face-to-face the physician believes the
encounter with the patient patient has a life
no later than 30 days prior expectance of 6 months or
to the 3rd benefit period less
recertification and each • Effective January 1, 2011 for
subsequent recertification qualifying benefit periods
(60-day periods) – Patients in 3rd benefit period
or later in 2011 will have to
have the F2F encounter and
the F2F documentation
24. Hospice Face-to-Face Encounters
• Certifications and • Hospice physician MUST
recertifications must be employed or working
show the dates of the under arrangement with
benefit period to which a hospice.
they apply • Hospice physician who
• F2F encounters are non- has the F2F encounter
billable on Hospice claims must be the same
physician who is
composing the narrative
and signing the
certification.
25. THANK YOU!
If you are interested in more news and
Updates, please visit my blog at:
http://blog.healthcarefirst.com/regulatory-blog/
For more information about our products and
services, please contact HEALTHCAREfirst at
800-841-6095