Print Page | Sign In | Register
Hot Topics Blog
Blog Home All Blogs
The Hot Topics blog hosts news and views by HCAF leadership, home care providers, and industry professionals who serve home care providers. People are talking about the topics addressed here. Read up. Join in.

 

Search all posts for:   

 

Top tags: Centers for Medicare & Medicaid Services  CMS  Medicare  CMS Open Door Forum  HHCAHPS 

CMS Open Door Forum Provides Claims Processing, Payment, and Quality Updates for Home Health

Posted By Kyle Simon, Monday, August 27, 2018
Last week's Centers for Medicare & Medicaid Services (CMS) Open Door Forum included an update on home health claims processing and quality reminders, including:
  • CMS claims processing staff announced that the National Uniform Billing Committee (NUBC) recently approved a new value code (85) to report Federal Information Processing Standards (FIPS) state and county codes in relationship to the CY 2019 rural add on changes. CMS will issue a formal notice on this new value code following publication of the final CY 2019 home health payment rule later this year. This value code does NOT replace the CBSA code as that is still needed.
  • An OASIS-D guidance ERRATA is available in the Downloads section of OASIS Users Manual webpage.
  • Agencies that they are responsible for monitoring data submission by their selected vendor and ensuring that their HHCAHPS vendors are submitting surveys on a timely basis.
  • Data submission deadlines for HHCAHPS are the third Thursday of the assigned month (January, April, July, and October). The next deadline is October 18, so please check your data prior to that date.
  • Agencies are responsible for submitting a list of patients on a monthly basis to their HHCAHPS vendors in a timely manner.
  • If a HHA has switched vendors, please contact RTI to make sure that the current vendor is authorized to submit your data and that your former vendor has been removed.
  • HHCAHPS vendors are required to get CMS approval to display a provider's name and/or logo to ensure HIPAA requirements are met.

Tags:  Centers for Medicare & Medicaid Services  CMS  CMS Open Door Forum  HHCAHPS  Medicare 

PermalinkComments (0)
 

CMS Issues Further Clarification on Provider MSP Responsibilities

Posted By Kyle Simon, Monday, August 27, 2018

Medicare-participating providers are required to determine whether Medicare is a primary or secondary payer for each admission, start of care, or encounter with a beneficiary prior to submitting a bill by asking the beneficiary about any insurance coverage that may be primary to Medicare. The Centers for Medicare & Medicaid Services (CMS) has a model questionnaire containing the information questions that should be asked of beneficiaries at each start of care.

In response to recent questions, CMS has issued a Transmittal and MLN Matters article (Transmittal 123/Change Request 10863/MM10863) that updates Chapters 3 and 5 of the Medicare Secondary Payer Manual to provide clarification of requirements for provider-based entities as well as to re-emphasize that providers may also view the Common Working File (CWF) or reference the X12 270/271 Transaction Set to access current information on file and confirm with the patient if insurance information has changed. If there are no changes, the MSP questions do not need to be asked.

Of particular relevance to home health and hospice providers are CMS’ reemphasis (as part of the Medicare Secondary Payer manual revisions and as part of MM10863) that a provider may, in lieu of initially asking the patient to complete the model questionnaire, refer to information contained in the CWF or X12 279/271 Transaction Set to confirm with the patient whether the information has changed. CMS gives the following guidance:

  • If you have access to the Common Working File (CWF), your admission staff may ask the beneficiary if any insurance information it contains has changed. If there are no changes to the beneficiary’s insurance, then there is no need to ask the questions. Further, you are required to:
    • Notate (for auditing purposes) that all the questions were not asked upon admission based on the beneficiary’s statement that their insurance information has not changed. Notations may be cited on the CWF screen print verifying the MSP information in the system is correct or the notations may be attached to the CWF print out. Your MAC may request this notation and confirmation during review
  • Alternatively, the HIPAA Eligibility Transaction System (HETS) Health Care Eligibility Benefit Inquiry and Response (270/271) Transaction Set may be used to make an inquiry about the Medicare eligibility of an individual and to identify insurance that is primary or secondary to Medicare. Similar to the CWF process (above), if you have the ability to submit and receive a HETS 270/271 transaction set and, upon review, there are no changes to the beneficiary’s insurance then there is no need to ask the questions.
    • Further, you must notate (for auditing purposes) that all the questions were not asked upon admission based on the beneficiary’s statement that their insurance information has not changed as your MAC may request this notation and confirmation during review. Notations may be cited on the 270/271 screen print verifying the MSP information in the system is correct or the notations may be attached to the HETS 270/271 print out.
  • If, upon checking either the CWF or 270/271 information with the beneficiary you find that there ARE changes to the insurance information, you must ask the MSP questions.
– Provided by National Association for Home Care & Hospice (NAHC) staff.

Tags:  Centers for Medicare & Medicaid Services  CMS  Medicare 

PermalinkComments (0)
 

Associate Members