Beginning October 7, 2024, the Centers for Medicare & Medicaid Services (CMS) will implement significant changes to hospice claims processing, as detailed in Change Request (CR) 13531 and the FY2024 Hospice Wage Index and Payment Rate Update final rule. These changes are designed to enhance hospice program integrity and ensure that claims are compliant with…
Author: Amy Ross
Hospice Outcomes and Patient Evaluation
On Monday September 16th, 2024 CMS posted the final version of the HOPE (Hospice Outcomes and Patient Evaluation) tool that is effective beginning October 1, 2025. The HOPE tool will take the place of the HIS (Hospice Item Set) but does include many of the same items. Medicare-certified hospices will complete HOPE records for all…
New Home Health Quality Measure
How effective is your agency when it comes to improving functional outcomes for your patients? Beginning calendar year 2025, home health will have a new quality measure that will report how successful agencies are at achieving an expected level of functional ability at discharge. CMS recognizes that home health care has a positive impact on…
Expanded Hospice Oversight
The U.S. Centers for Medicare & Medicaid Services (CMS) will expand its enhanced oversight for new hospices in California, Nevada, Arizona, and Texas to combat fraud, waste, and abuse. This includes prepayment medical reviews of claims before payment by Medicare Administrative Contractors (MACs). Initial review volumes will be low and adjusted based on compliance, but…
Balancing Innovation with Robust Security in Hospice Care
The integration of technology into end-of-life care is revolutionizing hospice services, bringing both significant opportunities and complex challenges. On one hand, advancements such as artificial intelligence (AI), predictive analytics, and telehealth have greatly enhanced care delivery, streamlined operations, and improved both patient outcomes and staff satisfaction. On the other hand, these innovations have introduced new…
FY2025 ICD-10-CM Update
On July 3rd, 2024, the CDC released the FY2025 ICD-10-CM update. The 252 new codes, 36 deletions, and 13 code revisions go into effect on October 1st, 2024. There are a few upcoming changes that are of particular interest: The following new codes will provide additional information regarding the severity of Hypoglycemia when that is…
Compliance Audits
Home health and hospice agencies are facing heightened audit scrutiny from various entities, including the Centers for Medicare & Medicaid Services (CMS), Office of Inspector General (OIG), Unified Program Integrity Contractors (UPICs), Medicare Administrative Contractors (MACs), and state health departments. These audits focus on ensuring accurate billing and reimbursement, compliance with federal and state regulations,…
Home Health Proposed Rule Seeking Comment on Assessments by Therapists (PT, SLP, OT)
CMS seeks public comments regarding whether CMS should shift its longstanding policy and permit all classes of rehabilitative therapists (PTs, SLPs, and OTs) to conduct the initial assessment and comprehensive assessment for cases that have both therapy and nursing services ordered as part of the plan of care. They are asking the public for data,…
Hospice CARE Act Set To Reform Hospice
Rep. Earl Blumenauer (D-Oregon) announced draft legislation, the Hospice Care Accountability, Reform, and Enforcement (Hospice CARE) Act, on June 13, 2024, aiming for transformative reforms to hospice payment systems and regulatory oversight. The hope is to be introduce the bill in Congress later in 2024. A key element of the Hospice CARE Act is the…
CMS issued Change Request (CR) 13543 on 04/11/24 with Subject Line: Additional Enforcement of Required County Codes on Home Health Claims
While the stated purpose noted on this CR was to create an edit in the original Medicare systems to ensure required county codes are reported on all home health claims, other interesting tidbits were included. This CR was stated to also make makes clarifications to home health billing instructions regarding Notice of Admission timeliness exceptions,…
