Your MHPCA Monthly Quality and Compliance News
Jane Moore
MHPCA Quality & Compliance News
Your
Monthly
Hospice
& Palliative
Care
Regulatory
Resource
Keeping you up-to-date on the ever-changing world of hospice and palliative care. Please share this summary with your staff to ensure they are aware of items pertinent to their areas of responsibility.
NATIONAL NEWS – CMS / MEDICARE / OIG / DEA / ETC.
September 2016
All Providers
Clarification of Requirements of the Nondiscrimination Rule
Attention: All Provider Types
The Carolinas Center has shared information in prior issues of Hospice Report to inform providers of the new rule, Nondiscrimination in Health Programs and Activities. The rule addresses an Assurance of Compliance form (HHS 690) and the language is not clear about submission of the form. TCC staff reached out directly to the HHS contact person to verify the form requirements. The form must be submitted when new providers first apply for Medicare or Medicaid certification or when there is a change in ownership for an organization. Existing providers are NOT required to submit the Assurance of Compliance form. Additional information, including FAQs, are available on the website for the rule.
Attention: Human Resource Staff of All Providers
The updated list of excluded providers has been posted by the OIG. All providers need to regularly compare the list to its employee, physician and contract vendor list to ensure there is no relationship with any of the excluded individuals or companies. It is best practice to review the full list in case someone was added to the list through activities in another state. MHPCA has downloaded July’s list of added individuals. All of the updated files are posted at https://oig.hhs.gov/exclusions/exclusions_list.asp.
MLN Matters Article Addresses Reporting of Provider Enrollment Changes
Attention: All Providers
CMS has published the MLN Matters Article, Timely Reporting of Provider Enrollment Information Changes, to ensure that all providers are aware of what is needed to comply with reporting requirements.
Per 42 CFR Section 424.516(d), all physicians, non-physician practitioners and physician and non-physician practitioner organizations must report changes in their enrollment information to Palmetto GBA via internet-based PECOS or the CMS 855 paper enrollment application.
Changes in ownership, an adverse legal action, or a change in practice location must be reported within 30 days of the change. Other changes must be reported within 90 days. Review this article to ensure your agency is current on reporting all changes in enrollment.
Multiple Managers & Staff
FY2017 Final Rule & Wage Index Charts Posted
As reported previously, the FY2017 Hospice Final Rule has been published. CMS posted a factsheet with highlights of the main provisions. The full rule is available in the July 29 Federal Register version or the pre-Federal Register (easier to read) version. The final rule will be effective October 1, except that data collection for the new quality measures does not begin until April 1, 2017.
NHPCO has prepared the Wage Index State-County Charts and authorizes TCC to share these with our members. View the full set of charts for all states.
Remember that the payment rate update does not take sequestration into account, but that 2% reduction will remain in effect. In addition, any hospice not meeting the quality reporting requirements will be subject to an additional 2% reduction.
The final rule implements new requirements as part of the Hospice Quality Reporting Program. Data will be collected with the Hospice Item Set (HIS) forms so CMS will revise the HIS forms and conduct provider education prior to the implementation. The two new measures are summarized below:
• Hospice Visits When Death is Imminent Measure Pair – To assess hospice staff visits to patients and caregivers in the last week of life – only for Routine Home Care level
- Measure 1 – Assess percentage of patients receiving at least 1 visit from a RN, MD, NP or PA in the last 3 days of life
- Measure 2 – Assess the percentage of patients receiving at least 2 visits from a MSW, Chaplain, LPN or Aide in the
last 7 days of life
- Excludes patients with length of stay of less than or equal to 1 day (i.e., admitted and discharged on the same day)
• Hospice and Palliative Care Composite Process Measure – Comprehensive Assessment at Admission – This measure will use the current quality measures from the HIS
- Will calculate the percentage of patients whose HIS Admission record has data on all seven element
- Will address 4 domains – Structure and Processes of Care, Physical Aspects of Care, Existential Aspects of Care, and Ethical and Legal Aspects of Care
Clinical Managers and Compliance Staff
CMS Publishes Medicare Part D Drug Cost Data
Attention: Physicians & Clinical Managers
CMS has released data on the prescription drugs that were paid for under the Medicare Part D Prescription Drug Program in 2014. This is the second annual release of the data and it provides information on the drugs prescribed by physicians and other healthcare professionals. The release is part of CMS’ commitment to transparency around government data.
CMS notes that the data set contains information from more than one million health care providers who prescribed approximately $121 billion in prescription drugs paid for under the Medicare Part D program. A March 2016 HHS report provided a detailed analysis of prescription drug spending trends, and noted that overall prescription drug spending in the United States rose by 12.6 percent between 2013 and 2014.
CMS now has two years of data and can analyze it for trends related to medications and prescribers. They will be looking to see if there are variances among providers, drugs prescribed, and drug utilization. New to this report is aggregated information on opioids, antibiotics, antipsychotics, and high-risk medications among the elderly.
Providers are encouraged to review the information for the prescribers in their agency by using the Medicare Provider Utilization and Payment Data: 2014 Part D Prescriber Look-up Tool. CMS has recently indicated that they are concerned with the number of claims billed to Part D for patients enrolled in hospice. Since CMS expects most medications to be the hospice’s responsibility, few medications should be billed to Part D. CMS is closely monitoring this data and may issue additional requirements to ensure proper billing of medications to Part D.
It is important to remember that if a medication is related to the terminal illness or related conditions, but is not included in the hospice plan of care such as when it is not clinically indicated, then the patient is responsible for payment and the drug should not be billed to Part D. For example, a patient with end-stage heart disease is taking a statin drug. The hospice physician determines that the medication is no longer efficacious and the attending MD concurs. If the patient insists on taking the statin drug, then payment will be the patient’s responsibility and the drug cannot be billed to Part D.
Hospices must work closely with patients, families, attending MDs, pharmacies and Part D plan sponsors to ensure that everyone is aware of who is responsible for payment for all medications the patient is receiving.
View a fact sheet and the Part D Prescriber Data CY 2014 webpage for more information and an explanation of the various files available for review.
Hospice Certification Form Tip
Attention: Clinical Managers & Compliance Staff
Palmetto GBA has posted a short article entitled, Hospice Tip: Benefit Period, to remind providers of the requirement that benefit periods be included on the certification of terminal illness (CTI) form. The article reviews other CTI requirements. Read this article to ensure your process is accurate to avoid claim denials on medical review.
Quality Management Staff
Information Posted on Updates to HIS Forms
In preparation for collecting data on the new quality reporting measures outlined above in the FY2017 rule article, CMS has posted “Supporting Analyses for Updates to the HIS V2.00.0.” The analyses outline findings from the HIS V2.00.0 pilot study and a technical expert panel. Changes are being made to add a new section to the HIS-Discharge form to collect details for the Hospice Visits when Death is Imminent Measure Pair. In addition, a new item will be added to Section J: Pain in the HIS-Admission record. The HIS V2.00.0 is scheduled to be implemented April 1, 2017. EMR vendors need to begin now to prepare for these changes.
Hospice Quality Reporting Program Updates
CMS continues to prepare for the collection of data to inform two new quality measures that will be implemented April 1, 2017 and for public reporting of hospice quality data. Information is being shared on the Hospice Quality Reporting Program (HQRP) website as well as through newsletters and the Open Door Forum. CMS has posted several updates to the HQRP page related to the Hospice Item Set (HIS) and CAHPS Hospice Survey requirements:
• HIS Question & Answer Document for 2nd Quarter – This reflects the questions frequently received by the Help Desk during the 2nd QTR of 2016. Other updates are included.
• Timeliness Compliance Threshold Fact Sheet – This updated document provides information on the new Hospice Timeliness Compliance Threshold Report in CASPER.
• 2016 CAHPS Hospice Survey Training – This educational event will be held September 28. More information will be posted at a later date at www.hospicecahpssurvey.org.
• Hospice QRP Webinar Training Materials – The Download section of this page includes the PowerPoint presentation, recording, and a Q&A document from the May 10 QRP webinar.
• Hospice Data Specs – An updated version of the Hospice Item Set (HIS) data submission specifications (v2.00.0) is now available and is effective April 1, 2017. CMS notes that there were no changes from the previously posted draft version of these specifications. This version of the data specifications consists of several files which are in the Downloads section of the HIS Technical Information webpage.
• Hospice Data Directory – As reported previously, CMS has posted a Hospice Data Directory that includes high-level demographic data pulled from ASPEN for all Medicare-certified hospices from ASPEN. Agencies need to verify that their listing information is correct as this will be used for public reporting in 2017.
If the data is incorrect or missing, CMS has stated that hospices should contact the CMS Regional Office Coordinator as outlined on the webpage. But this is inaccurate for many states and CMS acknowledged this on the 8/23 Open Door Forum. Providers can contact the CMS coordinator or their state survey agency for verification of the correct contact for updates.
Finance, Billing and/or IT Staff
Discharge & Revocation Resource
Attention: Billing Staff
Palmetto GBA has updated the Hospice Discharges and Revocations Chart which includes discharge reason and status codes. Please review this document and share it with your staff.
Reminder – Principal Diagnosis Code Required on NOE
Attention: Hospice Billing Staff
If the principal diagnosis is missing, the NOE will be rejected and the provider will receive a message. CMS announced this in Change Request 9575, Making Principal Diagnosis Codes Mandatory for Notice of Election (NOE) to be Accepted. Ensure that all NOEs include a principal diagnosis!
CMS Creates New Condition Code for Late Recertifications
Attention: Hospice Billing Staff
CMS published Change Request 9590, New Condition Code to Use When Hospice Recertification Is Untimely and Corrections to Hospice Processing Problems on August 5. The change is effective for claims received on or after January 1, 2017. The CR creates a new condition code (85) for hospices to place on the claim to indicate that occurrence span code 77 period is used due to a late recertification of the terminal illness. Several payment issues and manual updates are addressed as well.
The Occurrence Span Code (OSC) 77 is used in two instances – late notice of election and late recertification – and currently the Medicare systems cannot differentiate the two uses. At this time, claims are rejected in error when the occurrence code 27 falls within the OSC 77 dates and the OSC 77 was used to report an untimely NOE. CMS asked the National Uniform Billing Committee (NUBC) to create a new code to indicate which circumstance is causing the hospice to use OSC 77. The new condition code 85 is defined as "Delayed recertification of hospice terminal illness." A claim edit will verify that the occurrence code 27 date does not fall within the OSC 77 dates.
The transmittal also corrects a number of problems in hospice claims processing to ensure correct payment of the two-tiered Routine Home Care rates and the Service Intensity Add-On (SIA).
• Currently, the Medicare system is only checking the most recent benefit period, but needs to check all benefit periods not separated by a 60-day break in service. (Business Requirement 9590.4)
• There are situations in which hospices are not receiving SIA payments when the patient dies in the first seven days of the month and is not on the RHC level. The system should look back to the prior month and is not. Also, adjusted claims are causing an issue with SIA payments. (Business Requirement 9590.5 and 9590.6)
• In transfer situations, the receiving hospice is receiving a denial when the transferring hospice files their NOE late. The action of the discharging hospice should not impact payment for the receiving hospice. (Business Requirement 9590.7). MACs will override the edit between now and January 1 when the system updates are effective.
Lastly, several routine revisions were made to hospice billing instructions in Chapter 11 of the Medicare Claims Processing manual to ensure compliance with industry standards. Review the MLN Matters article and the transmittal for full details.
Palliative Care Providers
ICD-10 Coding Flexibility Ends on September 30
Palliative care providers may remember that CMS had stated that Part B providers would be afforded some flexibility in coding such that claims would not be denied if the ICD-10 code was not as specific as it needed to be. This flexibility is no longer effective on October 1, 2016. CMS has posted updates to the Clarifying Questions and Answers Related to the July 6, 2015 CMS/AMA Joint Announcement and Guidance Regarding ICD-10 Flexibilities. Pay particular attention to Question 25 which indicates that providers must code to the highest specificity.
Jane Moore
CEO
Missouri Hospice & Palliative Care Assn.
600 Monroe Street
Suite 300
Jefferson City, MO 65101
Phone 573-634-5514
Fax 573-635-0659
Please save the date for the Midwest Conference October 2-4, 2016 Tan-Tar-A Resort
Have you signed your aides up for EDNA? Mohospice.telspanexam.com
Nick Goodrich
How long do i need to save patient records after i have closed my business? I have filed an IRS 966 and closed the corporation down. There is no building, no assets and no employees.
Thank you,
Nick Goodrich
VNA-TIP Hospice
St. Louis, MO