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Open Door Forum Summary: Updates on iQIES Transition Update and Home Health

Monday, January 13, 2020   (0 Comments)
Posted by: Kyle Simon

Courtesy of the National Association for Home Care & Hospice (NAHC)

The Centers for Medicare & Medicaid Services (CMS) held a Home Health, Hospice, & DME Open Door Forum (ODF) on January 8, 2020. A summary is provided below, beginning with home health and followed by hospice.

iQIES Transition

CMS indicated in the ODF that it is aware of several issues with the iQIES transition. This was also the primary topic providers and stakeholders brought up during the Q&A portion of the ODF. NAHC is also receiving many inquiries about various issues and we have been in touch and continue to communicate with CMS about these issues. Thus far, CMS has indicated that it is aware of the issues and is working to resolve them. Based on a suggestion during the ODF Q&A session, CMS is working on developing an iQIES issues log that would be available to the public and would identify the various issues being experienced and the status of a resolution for each of the issues. As stated above, NAHC continues to work with CMS on these issues and requesting that providers are not penalized due to submission issues that are the result of the iQIES transition and out of the provider’s control.

Patient-Driven Groupings Model Update

CMS indicated that there has been a correction to Change Request (CR) 11081. This CR deals with the implementation of the Patient-Driven Groupings Model (PDGM) and was reissued on December 20, 2019. However, the CR Request for Anticipated Payment (RAP) percentages are incorrect as they showed at the percentages prior to the CY 2020 home health final rule changes RAPs will be paid at 20% in accordance with the final rule, and a further corrected CR is expected to be issued later this week.

Medicare quarterly system releases are always installed the first weekend of the first quarter. This happened this past weekend. Medicare Administrative Contractors (MACs) typically hold claims for a brief period each quarter when they implement system releases. This January, home health RAPs are affected by implementation of the PDGM. MACs will hold RAPs with From Dates on or after January 1, 2020, and process them once the updates are complete. This should result in little or no delay in payment. The hold typically does not include RAPS but it does this year to allow new HIPPS code to be loaded. CMS indicated the MACs are expected to release 2020 RAPs in the next few days if they’ve not already done so.

Home Health Quality Reporting Program 

New for this year is an introduction to HH CAHPS Survey, Self-paced Training Module. This can be accessed from the home health CAHPS survey website training page.

There is also a required Home Health Care CAHPS Survey Vendor Training Update on January 31, 2020 from 12:00 to 2:00 p.m.ET. This is the only time this training will be offered. Registration is required and can be found here. Again, all currently approved vendors are required to attend the update training.

Every agency is responsible for submitting a monthly list of CAHPS eligible patients to their survey vendor so sampling and data collection can occur according to schedule. If an HHA does not have any patients for the month, the agency must notify the vendor to record that there are no patients for this month. If the agency does not notify the vendor and the vendor in turn does not report that there were no eligible patients for the month, CMS will assume the agency did not participate in the CAHPS that month. The agency will then be subject to the two-percent penalty.

All agencies must monitor their vendor’s compliance with the data submission requirements via the CAHPS Survey Data Warehouse as the agency is held responsible, and subject to the two-percent payment update penalty, if the vendor is not compliant.

CMS reminds agencies, that if they are planning to change their survey vendor, it is best to contact RTI before doing so to assist with the transition. Providers can call RTI at (866) 354-0985 or email at

Per the 2020 home health Final Rule rule, CMS is removing the measure Improvement in Pain Interfering with Activity from Home Health Compare beginning with the April Compare refresh. Home health agencies are still collecting data for this measure, however, through CY 2020.

The January 2020 Compare refresh will be available on January 23. Please note CMS is no longer public reporting emergency department use without hospital readmission during the first 30 days of home health and rehospitalization during the first 30 days of home health on Compare beginning with this January 2020 refresh.

The OASIS Quarterly Q&As are scheduled to be posted on January 21, 2020.

CMS announced a recruitment notice for a Technical Expert Panel on functional outcome measures.

Review Choice Demonstration Update

The choice selection period for Texas will begin January 15, 2020 and end on February 13, 2020. Visit Palmetto GBA's provider portal for more information. Agencies that do not make a selection will automatically be placed in Choice 2. The Review Choice Demonstration (RCD) will begin in Texas on March 2, 2020.

Illinois is entering the new RCD cycle on February 1, 2020 with choice selection ending on January 13, 2020.

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