August 2018 Industry News

Top Deficiencies in 2018 So Far

Even though most of the deficiencies are in regards to the plan of care (the most common standard-level deficiency in 2018), over 70% of deficiencies involve emergency preparedness. Here are the top ten deficiencies, so far:

  • Plan of Care
  • Prevention
  • Home Health Aide Assignments & Duties
  • Emergency Prep Testing Requirements
  • Emergency Prep Training Program
  • Written Plan of Care Established and Periodically Reviewed
  • Conformance with Physician Orders
  • Policies and Procedures-volunteers and staffing
  • HHA Comprehensive Assessment in Disaster
  • Local, State, Tribal Collaboration Process

View the latest data here.

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Proposed Change to Simply Home Health Recertifications

CMS released on July 2nd a proposed regulation that says the physician wouldn’t have to predict how much longer a particular Medicare patient would need home care in order to be recertified by the agency. It is in response to concerns about the regulatory burden reduction and would help to reduce claim denials that result from an estimation missing from the recertification statement.

CMS also proposed to remove the following five outcome measures from the Home Health Value-Based Payment Model:

  • Influenza Immunization Received for Flu Season
  • Pneumococcal Polysacchairde Vaccine Ever Received
  • Improvement in Ambulation-Locomotion
  • Improvement in Bed Transferring
  • Improvement in Bathing

In 2020, Congress has been instructed to have the agency stop using the number of therapy visits made to determine payments and have thus proposed the Patient-Driven Groupings Model (PDGM) that would rely more heavily on clinical characteristics to determine the amount of payment and eliminate the use of the therapy threshold.

Is your agency meeting all of the Conditions of Participation? Are you collecting maximum reimbursement for your claims? Let us help you! Look at our Managed Services today.

New Medicare Home Health Proposed Rule

In July, CMS put out the 2019 Proposed Rule. Here are the basics:

Payment Rates

  • Rates set to increase by 2.1%
  • Rural Add-On Amount will depend on whether the HHA is in a frontier area (increase to 4%) or a high utilization area (drop to 2%). Any in between will receive 3%.
  • Outlier eligibility will be tightened with the Fixed Dollar Loss dropping to 0.51% from 0.55%
  • LUPA will not change.

2020 Payment Model – would start on January 1, 2020

  • 30 day payment unit
  • Therapy thresholds gone
  • Case Mix Adjustment Model with 216 categories using measures like “early” or “late” time period; institutional discharge or community admission; 3 functional levels; comorbidity adjustment
  • Behavioral adjustment to base rates to account for diabnosis coding and visit volume changes (-6.42%)
  • Budget Neutral rate setting except for behavioral adjustment
  • Combined care and non-routine medical supplies
  • 30 day LUPA ranging from 2-7 visits depending on case-mix
  • Possible end to RAPs

See more information here.

Don’t worry about all the changes. Leave the billing or revenue recovery to the experts. Check out our Revenue Cycle Management Services.


So Important, Had to Put in the Newsletter Again…


Ready for CMS’ New Review Choice Demonstration?

Pre-Claim Review has been revised and will now be referred to as the “Review Choice Demonstration” – set to begin on October 1, 2018.

The proposed changes are as follows:

  • 100% Pre-Claim Review
  • 100% Post Payment Review
    • Providers that choose one or the other will continue to be subject to a review method until the agency reaches the target affirmation or claim approval rate of 90%. Once it reaches the approval rating, it can choose to be relieved from the claim reviews (except for a spot check of 5%).
  • You can opt out of pre- and post-claim and accept a 25% payment reduction for all home health services and the possibility of a Recovery Audit Contractor (RAC) review.

Read the full proposal here.

HealthCare Synergy offers both TPE and RCD services! Take a look and let us help you! Our Clinical Staff has 100% Affirmation in PCR in Illinois.

OASIS-D Education Preparation

OASIS-D will be released on January 1, 2019. Final guidelines are set to be released in November of this year. It is expected that due to extra questions, OASIS-D will take longer to fill out than OASIS-C2. Here are a few of the changes so far:

  • GG0130-Self Care, GG0170-Mobility, J1800-Falls since SOC/ROC, and J1900-Number of Falls
  • M1311 has been standardized and will be used to measure Changes in Skin Integrity: Pressure Ulcer/Injury
  • M1313 will be Removed
  • GG0100-Prior Functioning and GG0110-Prior Device Use will be added to standardize data collected across post-acute-care settings.

For more information, see here.

We have OASIS Review, ICD Coding, & 485 Preparation Services to help you make sure you’re following all CMS’ guidelines.

We also have a WEBINAR on October 30, 2018 at 10am PST with Michael Tidd. Don’t forget to sign up!