Home Health and Hospice Coalition Met In Person with Palmetto GBA by Beth
Foster Regulatory Affairs Director
June 24, 2019 sixteen states under Palmetto GBA’s jurisdiction met with
Palmetto representatives to discuss Home Health and Hospice issues. Beth
Foster, Regulatory Affairs Director, Kathy Royer, Hospice Regulatory Director,
and Joe Russell, Executive Director from OCHCH were the only Ohio
representatives in attendance. The following are key points discussed:
Hospice Targeted Probe and Educate (TPE): Palmetto GBA has begun the process of Targeted Probe and Educate with Hospice providers. Currently 135 hospice providers from the Palmetto region will receive letters identifying the providers who will begin the first round of TPE. The focus area of the TPE audit is neuro NCLOS. You can review your level of risk by reviewing the electronic Comparative Billing Report (eCBR) which focuses on Non-Cancer Length of Stay (NCLOS) rates from October 1, 2018, to March 31, 2019. For your personalized Non-Cancer Length of Stay (NCLOS) eCBR results log on to eServices
HEALTH and HOSPICE: Home Health and Hospice providers who have a HETS ID or get
one, will lose access to the CWF eligibility queries this fall. Providers who
do not have a HETS ID will not lose access to CWF eligibility queries. In
addition, providers may have a concern when they log in DDE for CWF eligibility
queries after the July 2019 System Release implementation and see a message
about this. Detailed information can be found in the DDE
User’s Guide information
Below are two CMS postings on this.
Duplicate Provider Medicare Fee-For-Service (FFS) Beneficiary Health
Insurance Eligibility Systems – Updated
Eligibility Transaction System (HETS) to Replace Common Working File (CWF)
Medicare Beneficiary Health Insurance Eligibility Queries
The only providers affected by this action would be the ones that requested and received their own HETS ID by submitting a “Trading Partner Agreement (TPA) Form”, as discussed in How to Get Connected. Providers accessing HETS via a MAC portal would not lose CWF access, as they use the MAC’s HETS IDs in the portal.
SO, WHAT IS GOING ON WITH RCD???
Review Choice Demonstration (RCD) has just commenced implementation in Illinois
as the home health agencies (HHAs) have selected their review choice option. A
few Illinois HHAs have submitted documentation. At this time Palmetto
is expecting a 7-10 day turn around for affirmations (or not affirmed), and
then hope to decrease the turnaround to 3-4 days. The Illinois association is
working with Palmetto GBA to decrease duplication of documents, asking for
check boxes for codes, and requesting real time data.
YOU WANT TO KNOW – WHEN DOES OHIO START???
The Palmetto GBA staff does not know what state is next, nor when will that state start!
meets with CMS weekly and will be sharing the 16-State Coalition’s concerns.
SO, WHAT CAN OHIO’S HHAs DO NOW??? – Sign up for Palmetto’s eServices Portal NOW!
can only make their RCD option through the eServices Portal.
OCHCH will let you know as soon as we know when Ohio will be invited to the demonstration.
Beth Foster Regulatory Affairs Director