Category: Uncategorized

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,…

Substance Use Disorder Confidentiality Regulation

The U.S. Department of Health & Human Services (HHS) has announced a final rule, effective February 8, 2024, modifying the confidentiality regulations for Substance Use Disorder (SUD) patient records under 42 CFR Part 2. This aligns Part 2 with HIPAA and HITECH as mandated by the CARES Act of March 27, 2020. Key Changes:

Did the rules change regarding wound care as reasonable and necessary?

The rules did not change, but there has been a recent increase in Pre-Claim Review (PCR) non-affirmations when wound measurements and other clinical documentation is not submitted. In order for the wound care to be considered reasonable and necessary, the Medicare Benefit Policy Manual Chapter 7 – 40.1.2.8 Wound Care states, “the size, depth, nature…

Hospice Claim Edit

Beginning on May 1, 2024 a new claim edit will be implemented for hospice.  This edit is associated with the condition of payment that was finalized in the FY 2024 Hospice Wage Index final rule that requires hospice certifying physician(s) to be enrolled in Medicare or have a valid opt-out on file.  There are still…

Hospice Proposed Rule

The Centers for Medicare & Medicaid Services (CMS) posted the Proposed Fiscal Year (FY) 2025 Hospice Payment Rate Update  (CMS-1810-P) on March 28, 2024. The proposed hospice payment rate update includes an increase in the per diem rate of 2.6%.  This update is derived from the proposed inpatient hospital market basket update of 3.0%, with…

Occupational Therapy Month

April is Occupational Therapy Month and The American Occupational Therapy Association’s 2024 theme is Occupational Therapy: Advancing Health, Wellbeing and Quality of Life.  What is Occupational Therapy?  Simply put, occupational therapy enables people of all ages to participate in daily living.  Our lives are made up of occupations-meaningful everyday activities.  These occupations can include many…

Challenges In Providing Continuous Home Care To Hospice Patients

The Medicare Hospice Benefit affords patients four levels of care to meet their needs: routine home care, respite care, general inpatient care (GIP), and continuous home care (CHC).  For hospice providers, the majority of Medicare days of care were at the routine home care level of care for both percent of payments made and percent…

State Operations Manual (SOM) Appendix B Revisions

On March 15, 2024, CMS released Memorandum QSO-24-07-HHA. The memorandum summarizes changes made to State Operations Manual (SOM) Appendix B – Guidance for Surveyors: Home Health Agencies based on final rules which have amended home health conditions of participation. Key changes include:

Emergency Preparedness

Is your Emergency Preparedness Plan up to date? Monitoring your plan periodically ensures your staff and patients are prepared for disasters in your community. Develop/Review your All Hazards Plan: Identify new hazards, weigh the likelihood of current hazards, review recent hazards. Assess Recent Emergency Response: What worked well, what needs improvement, were there communication breakdowns,…

Navigating ADRs

Do you struggle with how to navigate Additional Development Requests (ADRs) and ensure accurate reimbursement? These tips will help put you on the right track. Understand the Purpose of ADRs: ADRs occur when payers request additional documentation to justify payment for specific services. Focus on the most common type: Pre-Payment Medicare Approved Contractor’s (MAC) “medical…