Jurisdiction M (JM) Home Health and Hospice (HHH) POE Advisory Group (POE-AG) Minutes: October 10, 2024

Published 10/29/2024

Facilitators: Dan George, Michael Bibbins and Marlene Frierson

Attendees: 24

Welcome

Our Goals

  • Establishing and maintaining strong relationships with Palmetto GBA and our provider community 
  • Meeting with Palmetto GBA and the provider community on a quarterly basis 
  • Providing the communication tools to facilitate thorough and prompt transfer of information 
  • Coordinating issues within the provider community to adequately reflect the concerns of the majority

POE-AG Goals and Purpose — HHH POE-AG Charter

Old Business: Prior POE-AG Suggestions/Recommendations — N/A

New Business: POE-AG Training Suggestions and Education Recommendations

Participating members have the opportunity to benefit the provider community by helping to guide Palmetto GBA educational strategy for the upcoming year.

Information to Share

Home Health

Reporting Federal Information Processing Standards State and County Codes on Home Health Claims Is Required — Effective October 1, 2024, creates an edit in the Original Medicare systems to ensure VC 85 and a corresponding FIPS state and county code are reported on all home health claims processed on or after the CR’s effective date. Medicare shall return to the provider home health claims TOB 032x (other than 032A or 032D) if VC 85 and a corresponding FIPS state and county code are not present.

Hospice


RCD News

  • Home Health Review Choice Demonstration Extended Five More Years — Effective June 1, 2024, CMS will extend the Review Choice Demonstration for Home Health Services for an additional five years. The demonstration will continue in the current demonstration states of Illinois, Ohio, Texas, North Carolina, Florida, and Oklahoma.

As part of the extension, CMS removed Choice 3: Minimal Review with 25% Payment Reduction from the initial choice selections. Palmetto GBA has proactively reached out to coordinate with the small number of affected providers to make a new review choice selection beginning July 1, 2024.

Coming Soon

Additional Implementation Edits on Hospice Claims for Hospice Certifying Physician article outlining the November 18, 2024, updates. Hospice Certifying Physician Billing Instructions — This article was posted on October 25, 2024.

Upcoming Education Events

2024 Hospice MACtoberfest Billing and Reimbursement Conference, San Antonio. The Texas & New Mexico Hospice Organization (TXNMHO) is partnering with Palmetto GBA to host the MACtoberfest 2024 Hospice Billing and Reimbursement Conference, in San Antonio, Texas, October 16–17, 2024.

eServices

  • We've Made it Easier to Keep Your eServices Account Active — This enhancement is ideal for providers that don’t utilize the eServices portal on a regular basis. This new change no longer requires the need to login. Users will receive an email that contains a link to keep your account active.
  • eServices Displays Accountable Care Organization Model Information — On January 2, 2024, eServices made an update to display information on the ACO models for Part A, Part B and HHH providers that are participating in an Accountable Care Organization. A new menu tab, ACO, will display to provider account administrators.

Open Discussion

Member Comment: Under the 2. Standard Waiver List for Hurricanes and Natural Disasters v. Sept 2021 (docx) (PDF), hospices may find the information beneficial that CMS may cover SNF stays without a three-day prior inpatient hospitalization.

Member Comment: The enhancement to the eServices portal to make it easier to keep eServices accounts active is well received. It is an excellent update and a time saver. 

Question: For the Period of Enhanced Oversight for New Hospices in Arizona, California, Nevada and Texas, outlined in MLN7867599 — Period of Enhanced Oversight for New Hospices in Arizona, California, Nevada, & Texas (PDF), how many claims can be selected for review?

Answer: There is not a limitation to the reviews for the duration of the enhanced oversight period after the initial probe, for non-compliant hospices progressing to a subsequent probe. The initial probe is a limited review of claims based on the hospice’s census. Subsequent probes on non-compliant hospices will have an increase of reviews. 

Please see the results of the probe in the articles below, where only 3 of 43 hospices were compliant and removed from the probe. 

Question: Would a hospice be subject to the expanded prepayment review and related activities for existing hospices in Arizona, California, Nevada, and Texas and a Targeted Probe and Educate (TPE) review at the same time?

Answer: The MACs shall exclude providers included in this expanded prepayment review from Targeted Probe and Educate (TPE), to prevent overlap.

Question: With the split implementation of CR 13531, Additional Implementation Edits on Hospice Claims for Hospice Certifying Physician Medicare Enrollment, how should hospices be reporting physicians, nurse practitioners or physician assistants (if applicable) on claim submissions.

Answer: Please see the Hospice Certifying Physician Billing Instructions article. Do note that the instructions for admission claim submissions (occurrence code 27 and the date of certification matches the claim’s admission and "from" dates) change on November 18, 2024. Non-admission claim submissions (admission date and claim "from" date do not match) do not change, regardless of submission date, going forward.

Next Meeting: The 2025 HHH POE-AG dates will be announced at the Provider Outreach and Education Advisory Group (POE-AG) web page when available.


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