• PALLATIVE CARE and HOSPICE: Primary Care First is Currently Accepting Practice Applications, CMS ListServe, December 2, 2019

• HOSPICE: OIG: Hospice Nurses Failed to Assess Aides in 99,000 Cases, Hospice News, December 2, 2019

• HOME HEALTH: HHAs: Avoid Payment Delays, Register for iQIES by December 23 Act now!

OCHCH Members: Thank you very much for participating in OCHCH’s RCD WEEKLY CALLS!

OCHCH recently launched an awareness campaign to provide your agency with the assistance, information, resources, and training you need to tackle the challenges of RCD and PDGM. This campaign is called OPERATION: tackle.

As part of OPERATION: tackle we are hosting weekly conference calls on RCD that started on October 25th and will continue for the foreseeable future. These conference calls will provide an opportunity for us to share the latest developments of RCD, for you to share your challenges, and for our members to share best practices in a real time environment.

Next OCHCH Weekly RCD Conference Call – Friday, DECEMBER 6, 2019 at 10am!

The following webcasts are(were) hosted by the MACs:

Home Health Patient-Driven Groupings Model (PDGM) Webcast Part Two: December 5, 2019

This is second part of two collaborative webcasts about the Home Health Patient-Driven Groupings Model (PDGM), hosted by your Home Health Medicare Administrative Contractors (MACs), CGS, National Government Services and Palmetto GBA. This presentation will begin on Thursday, December 05, 2019 at 02:00 PM Eastern Standard Time. During this webcast, you will receive information to help your agency prepare to implement clinical changes for the PDGM on January 1, 2020. PDGM is the Medicare payment model used to reimburse home health agencies. Please plan to attend.

Recording of the Home Health Patient-Driven Groupings Model (PDGM) Webcast Part I: November 21, 2019 is now available, but new viewers need to register to view it: SIGN INTO MEMBER PORTAL TO GET LINK

Payments and Payment Adjustments under the Patient-Driven Groupings Model, Palmetto GBA – This article provides information on the implementation of the new Home Health Prospective Payment System (HH PPS) case-mix adjustment methodology named the Patient-Driven Groupings Model (PDGM). The PDGM will be implemented for home health periods of care starting on and after January 1, 2020.  This MLN Matters Number: SE19028 is a very comprehensive tool to share with staff so they develop a better understanding of the PDGM.

OPERATION: tackle PDGM 
The OCHCH campaign to support your agency’s PDGM needs is up and running!

Helpdesk Question of the Week –
HOME HEALTH: PDGM and RCD

Question: Our agency selected the Postpayment Review option.  How will PDGM affect us?

Answer: HHAs in the Postpayment Review option will receive an Additional Documentation Request (ADR) for each 30-day period.

HHAs in Choice 4, Selective Postpayment Review, and Choice 5, Spot Check Review may have an increase of reviews due to the 30 day periods.

FYI – Every six months, HHA’s may select from one of the three subsequent review choices if the pre- claim review affirmation rate or postpayment review approval rate is 90 percent or greater. The subsequent review choices are: Choice 1: Pre-claim Review;  Choice 4: Selective Postpayment Review; or Choice 5: Spot Check Review.

Beth Foster, RN, BA, CPHQ, CEHCH

Our Take

OUR TAKE – Beth Foster, RN, BA, CPHQ, CEHCH

What is Livanta’s Memorandum of Agreement (MOA) for Healthcare Providers?

Livanta is a Beneficiary and Family Centered Care – Quality Improvement Organization (BFCC-QIO) that is responsible for medical case review, which supports the rights of individuals on Medicare in Ohio. These rights include protecting individuals when they receive health care and making sure they get the health care services the law says they can have. BFCC-QIOs can also help individuals with concerns about their care or if they request a review (appeal) of their discharge from a health care facility.

Home health and hospice agencies must inform individuals via the Notice of Medicare Non-Coverage (NOMNC, Form CMS-10123) at least 2 days prior to discharge that their care is ending. This gives individuals the time to request an expedited determination from Livanta. A Detailed Explanation of Non-Coverage (DENC) is given only if a beneficiary requests an expedited determination. The DENC explains the specific reasons for the end of covered services.

CMS restructured the BFCC-QIO regions effective on June 8, 2019 with Livanta covering Region 5 (OH, IN, IL, MI, MN, WI). At that time agencies should have been notified to complete a new Memorandum of Agreement (MOA) as required as a condition of your organization’s participation in Medicare.

If your organization has not yet submitted an MOA, or if you do not receive an email confirmation by October 1, 2019, please submit a signed MOA as soon as possible. As noted, MOAs are a Medicare requirement!

By the way – Livanta is required to report failures to complete the MOA directly to the CMS. To avoid this action, please complete your MOA as soon as possible. Livanta has set a deadline of December 31, 2019!!!

JUST DO IT!

• PALLITIVE CARE and HOSPICE: Now Available: New and Updated Primary Care First Resources, CMS Listserve, December 2, 2019 

• HOSPICE: Reminder–Hospice Quality Reporting Program Forum Webinar — December 4

• HOME HEALTH: National Provider Survey of Home Health Agencies, NAHC Report, November 27, 2019

• HOME HEALTH and HOSPICE: Ask the Contractor Teleconferences’ (ACTs) Questions and Answers: October 22, 2019 , Palmetto GBA

• HOSPICE and HOME HEALTH: Hospice and Home Health Claims Processing Issues Log, Palmetto GBA

• PALLIATIVE CARE: Researchers Work to Expand Palliative Care Among Native Americans, Hospice News, December 2, 2019

•  HOSPICE: Hospices Embrace Direct-to-Consumer Marketing, Hospice News, December 2, 2019