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…
Tag: CMS
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…
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…
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:
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…
Hospice Surveys & Complaints
When is the last time you entered a complaint in your grievance log? One of the core standards of focus for hospice surveyors is §418.52(b)-Exercise of rights and respect for property and person. The interpretive guidelines for this standard state that a “grievance is a formal or informal written or verbal complaint made to any…
HHVBP
Home health agencies are living in the midst of CMS’ expansion of Home Health Value-Based Purchasing (HHVBP) Model. There are quite a few intricacies to grasp regarding this program; however, CMS has published a self-assessment tool to help agencies get on track. An added bonus of this tool is the QAPI aspect. Don’t forget that MAC Legacy…
CMS Quarterly Q&As
CMS released the January 2023 Quarterly Q&As on Tuesday and among many topics, there is continued confusion surrounding the transition period. The Q&A guidance reiterates that the M0090 Date determines which version of the OASIS to complete and not necessarily the beginning date of the episode of care. The quarterly Q&As address questions that arise from real-life…
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…
