Dear Members,
There’s a lot going on at the Centers for Medicare and Medicaid Services (CMS), including rate and fee changes, and updates to information for hospice providers. Here is the latest news for licensed and certified agencies:
Home Health Prospective Payment System (HH PPS) Rate Update for 2019
If you are a home health agency billing Medicare Administrative Contractors (MACs), please be advised that CMS has completed its annual update to the Prospective Payment System rates and case-mix weights for home health services for calendar year 2019. Rates for services to Medicare beneficiaries in rural areas will be increased, as well. Please refer to MLN Matters Article MM10992 for updates to:
- 60-day national episode rates,
- the national per-visit amounts,
- Low Utilization Payment Adjustment (LUPA) add-on amounts,
- the non-routine medical supply payment amounts, and
- the cost-per-unit payment amounts used for calculating outlier payments.
Home Health Rural Add-on Payments Based on County of Residence
CMS has issued guidance in Medicare Learning Network (MLN) Article MM10782 for providers serving Medicare patients in rural areas, noting that, for home health services provided between January 1, 2019 and January 1, 2023, claims must contain the code for the county in which the services were provided. The National Uniform Billing Committee has created code 85, “County Where Service is Rendered” for this purpose. Please refer to MM10782 for details regarding how the rural add-on payment is applied, along with guidance for submitting code 85 and an associated Federal Information Processing Standards (FIPS) State and County code to your Medicare Administrative Contractor (MAC).
Provider Enrollment Fee of $586 for CY 2019 for new Enrollments and Revalidations
On November 16, CMS posted a notice in the Federal Register that institutional providers (such as home health agencies and hospice organizations) initially enrolling in Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP), as well as those revalidating their enrollment in these programs and those adding a new Medicare practice location, are required to pay a $586 fee for any applications submitted during calendar year 2019, an increase from the $569 fee in 2018. This fee must be paid online. Not sure if it is time for you to revalidate your enrollment? Check the Medicare Revalidation Lookup Tool online for your due date.
Hospice Comprehensive Assessment Quality Measure Fact Sheet Now Available
The Hospice and Palliative Care Composite Process Measure – Comprehensive Assessment at Admission (NQF #3235) describes the percentage of stays during which the patient received all of the care described in the other seven quality measures calculated using data from the Hospice Item Set (HIS) and the Hospice Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey, such as NQF #1634 Pain Screening, NQF #1641 Treatment Preferences, and NQF #1647 Beliefs/Values Addressed, among others. CMS advises that hospice agencies must perform all seven of the processes described in the quality measures at the time of admission to receive credit for this comprehensive measure of quality. Please refer to the CMS Fact Sheet for specific guidance on the calculation, interpretation, and reporting for this quality measure, as well as a Frequently Asked Questions (FAQ) reference tool. Hospice providers are not required to collect additional data for the calculation of NQF #3235; current HIS data is utilized to determine a score for this measure.
Speaking of the Hospice Item Set (HIS) …
Version 2.01 of the HIS Manual is now available! This updated version includes clarification to HIS coding instructions; HIS items were not changed.
That’s the latest from CMS! If you have any questions about these or other CMS topics, please don’t hesitate to contact us.
Thank you!