Prediction of terminal illness can be difficult for hospices. Local Coverage Determinations (LCDs) are guidelines developed by Medicare Administrative Contractors (MACs)—CGS, NGS, and Palmetto GBA—to assist hospices determine hospice eligibility. Although LCDs are not regulatory, the MACs use the LCD criteria in medical review. Therefore, hospice organizations are wise to follow the LCDs as much…
Author: Amy Ross
OASIS-E – M0090 Date
The implementation of a new OASIS data set—OASIS-E—is set to begin in January for Medicare-certified home health providers. However, the exact date of transition from OASIS-D1 to OASIS-E depends on the M0090 date. As a reminder, the M0090 item captures the date the OASIS assessment is complete. It’s defined as the last date the comprehensive…
Physician or Allowed Practitioner Signatures
Obtaining physician or allowed practitioner signatures on plans of care and/or verbal orders can be challenging at times for home health agencies. This, in turn, can delay submission of claims and payment. In the Medicare Benefit Policy Manual, Chapter 7, § 30.5.3, it states: “A physician or other allowed non-physician practitioner, other than the certifying physician…
ICD-10 Code Changes
A fairly large overhaul of the ICD-10 codes is set to begin on October 1st. In 2022, the update included 159 new codes while this year includes over 1,000 new codes. Added to that, well over 200 codes were deleted. It’s enough to make your head spin! Significant changes were made to dementia codes to…
Hospice Final Rule Implementation
Just over the horizon, October and everything pumpkin is approaching. This means the implementation of the hospice final rule for FY 2023–beginning on October 1st. This year’s final rule includes a rate increase of 3.8% for those hospices who submit required quality data. For those who don’t comply, a 2% payment penalty is assessed to…
OASIS-E New Items
Among the 27 new items slated for the new version of OASIS in January is O0110 – Special Treatments, Procedures, and Programs. This very useful data collection item identifies special treatments, procedures, and programs that apply to the patient during the time period under consideration (on admission, at discharge, or within the last 7 days)…
Emergency Preparedness
Hurricane season is upon us. The flu season is looming, and COVID-19 continues. In the midst of all of this, hospice and home health organizations need to ensure their emergency preparedness policies and procedures are reviewed and updated at least every two years. Within recent years, the healthcare industry has faced multiple changes—COVID related, emerging…
OSHA General Duty Clause
With the approach of Labor Day, the US pays tribute to the contributions and achievements of its workers. Recent years’ events have been intense as healthcare organizations have worked hard to keep their employees safe from COVID-19. OSHA standards play a large part of protecting workers in healthcare settings with standards for bloodborne pathogens, personal…
Social Determinants of Health (SDoH)
Within the past few years, there has been an uptick in government focus on health equity. Beginning in 2023, Medicare-certified home health agencies will be contributing data to CMS with new OASIS-E items which are dubbed “social determinants of health (SDoH)”. The components of SDoH are ethnicity (specifically asking about Hispanic, Latino/a, or Spanish origin),…
Claim Denial
Nothing can be quite as deflating to hospice leadership and staff as these words. Whether hospices are in the midst of TPE or other medical review, a common denial reason is failure to support the six-month terminal prognosis. Diagnosis alone may not suffice in establishing the physician’s prediction of the patient’s life expectancy. Hospices with…
