NHPCO Regulatory Round-Up May 2011
NHPCO Regulatory Recap for Activity from May 2011 Volume 1, Issue No. 5
To: NHPCO Membership
From: NHPCO Regulatory Team
Re: June 28, 2011
This issue of NHPCO’s Regulatory Round-Up contains the hot issues from May, 2011. Watch NewsBriefs for regulatory and compliance information each week or Regulatory Alerts for late-breaking significant news. Some regulatory issues will be featured only in Regulatory Round-Ups. Look for the “Extras” label following a topic, which will indicate that this Regulatory Round-Up is the only place this issue will be published. Regulatory Alerts and Regulatory Round-Ups can be viewed in their entirety on the NHPCO Regulatory & Compliance website at nhpco.org/regulatory. The past six months of NewsBriefs can be viewed on the NewsBriefs archive page. Member inquiries about regulatory and compliance issues may be sent via email to regulatory@nhpco.org.
IN THIS ISSUE:
- Billing Changes that Require Immediate Attention
- 2011 Cap Amount announced by CMS
- CIGNA “Future Effective LCDs” Now Available
- CMS Open Door Forum Notes
- Comprehensive Error Rate Testing – Evaluation and Management Services Fact Sheet
- Face-to-Face Resources, NEW from NHPCO
- Face-to-Face PowerPoint released
- FY2012 Hospice Wage Index Proposed Rule
- FY2012 Proposed Hospice Wage Index Rule Officially Publishes
- FY2012 Proposed Hospice Wage Index Correction Issued by CMS
- FY2012 Proposed Hospice Wage Index Rule Listening Sessions
- FY2012 Proposed Wage Index Tools
- HIPAA 5010 Updates
- HIPAA Version 5010 Implementation NEW Frequently-Asked-Questions Available
- ICD-10 Transition on Provider Practices
- Improvements to Medicare are Lowering Costs, Improving Care
- NOE Error Code E9351 Update
- OIG Issues Report About CMS HIPAA Oversight
- OIG Medicare Fraud: Download Compliance Training Materials
- OSHA Recordkeeping Rule Update
- Region C RAC Lists Two Hospice Related Audit Items
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Billing Changes that Require Immediate Attention… In the May issue of NewsLine, physician billing consultant, Jean Acevedo, discusses two upcoming changes that require the hospice provider’s immediate attention: Transition to the ICD-10 code set and the more imminent challenge of compliance with the new 5010 protocol for electronic claims submissions. Read the article online. |
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Cap Amount for 2011 announced by CMS... The hospice aggregate cap amount for the 2011 cap year is $24,527.69. The aggregate cap amount will also be released by CMS this summer in conjunction with the rates for FY2012. The cap amount notice is available online from CMS. |
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CIGNA “Future Effective LCDs” Now Available… CIGNA Government Services has worked closely with Cahaba GBA to identify and consolidate current LCDs during the transition of the hospice workload. These “Future Effective” documents are now available on CIGNA Government Services. CIGNA strongly encourages providers to closely review and familiarize themselves with all LCDs that became effective on June 13, 2011. |
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CMS Open Door Forum Notes…CMS held its Home Health/Hospice/DME Open Door Forum on Wednesday,May 25, 2011 and made several announcements related to hospice issues.CMS called attention to the CMS Ruling on the aggregate cap.Staff reminded listeners that the Federal Register published a correction to the Wage Index proposed rule on May 16, 2011. Questions about the issue of discharge when the face-to-face encounter is not done in a timely way were asked; CMS staff announced that they are working on the publication of a Change Request which will clarify the CMSexpectations about discharge. They made it clear that the face-to-face encounter is a certification requirement and if it is not done before the end of the benefit period, the patient is no longer considered eligible for the Medicare Hospice Benefit. NHPCO will provide information as soon as it’s available. |
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“Comprehensive Error Rate Testing – Evaluation and Management Services: Overview” Fact Sheet… A new publication, “Comprehensive Error Rate Testing (CERT) – Evaluation and Management (E/M) Services: Overview,” is now available in downloadable format from the Medicare Learning Network®. This fact sheet is designed to provide education on Evaluation and Management Services to Medicare Fee-For-Service providers, and includes information on the documentation needed to support a claim submitted to Medicare for medical services. Additional CERT resources: Palmetto - The ABCs of the Comprehensive Error Rate Testing (CERT) Program and How to Respond to CERT Requests. The Palmetto Medical Review Department has revised this article about responding to CERT requests. Cahaba - Errors Identified By The CERT Program. Before the crossover to CIGNA, the Comprehensive Error Rate Testing program randomly selected and reviewed Medicare claims to ensure they are compliant with Medicare regulations. Cahaba continually monitors CERT denials in order to prevent agencies from experiencing similar errors and lists these errors on the Cahaba website. |
May 2011 Regulatory Round-Up Extra |
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“Face-to-Face” Resources, NEW from NHPCO… To assist hospice providers with the certification and recertification process, NHPCO has developed two new tools to help inform patients about the face-to-face encounter requirement:
Download these free tools from nhpco.org/facetoface. |
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Face-to-Face PowerPoint Released… CMS has released an informational PowerPoint for hospice providers that describes the face-to-face encounter and the regulatory requirements. The PowerPoint is available on the CMS website. |
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FY2012 Hospice Wage Index Proposed Rule… CMS has posted the FY2012 Hospice Wage Index proposed rule (CMS-1355-P) on the Federal Register public inspection website. NHPCO prepared an initial analysis of the proposed rule available in an NHPCO Regulatory Alert (05/03/11). NHPCO has also prepared a separate document showing the proposed regulatory language within the applicable section of the Hospice CoPs. |
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FY2012 Proposed Hospice Wage Index Rule Officially Published… On Monday, May 9, the Federal Register officially published the proposed FY2012 wage index rule. |
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FY2012 Proposed Hospice Wage Index Correction Issued by CMS… On May 16, 2011 CMS issued corrections to the Proposed FY2012 Hospice Wage Index rule, which was published in the Federal Register on May 9. In addition, the wage index values for rural areas in each state were inadvertently left off the May 9 publication. They are included in the CMS correction as Addendum B. |
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FY2012 Proposed Hospice Wage Index Rule Listening Sessions… NHPCO hosted two free “Listening Sessions” for provider members to help them learn more about the proposed rule and to share issues and concerns. The various components of the proposed rule that were covered include: Components of Proposed FY2012 Hospice Wage Index Rule
Updates on Issues Not Proposed for Rulemaking in FY 2012
NHPCO incorporated provider concerns in the official NHPCO comment letter on this proposed rule. |
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FY2012 Proposed Wage Index Tools… NHPCO is pleased to offer a Quick Estimated Rate Calculator for FY2012 with estimates on rates based on information provided in the proposed rule. The Quick Estimated Rate Calculator is tab 1 on NHPCO’s proposed FY2012 Wage Index Excel document; the State-by-State/County-by-County spreadsheet is tab 2 in the Excel document. The “Quick Estimated Rate Calculator (tab 1) will require the provider to look up their wage index on the second spreadsheet (tab 2) where wage index values are listed by CBSA code or rural area. FY2012 Wage Index tools can be found on the Wage Index page of the Regulatory section of NHPCO’s website. More information will be available once the FY2012 wage index rule is published in final form later this summer. |
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HIPAA 5010/D.0 Important implementation Items… January 1, 2011 marked the beginning of the 5010/D.0 transition year. Reminders
Readiness Assessments
5010/D.0 Implementation Calendar Upcoming Events
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May 2011 Regulatory Round-Up Extra |
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HIPAA Version 5010 Implementation NEW Frequently-Asked-Questions Available… CMS has posted 18 new FAQs about HIPAA Version 5010 implementation, and one PDF document containing 27 Q&As specific to the March 30 CMS-hosted 5010 national provider teleconference on provider testing and readiness. To review these FAQs, visit the CMS FAQ database. |
May 2011 Regulatory Round-Up Extra |
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ICD-10 Transition on Provider Practices… The ICD-10 transition is approaching and affects everyone covered by the Health Insurance Portability and Accountability Act, even those who do not submit Medicare claims. If you are a provider, here are a few of the many areas where the transition to ICD-10 will affect your practice:
On January 1, 2012, all electronic claims must use Version 5010, and anyone covered by HIPAA must use ICD-10 diagnosis codes for services provided on or after October 1, 2013. To be prepared for both of these transitions, you should begin planning now if you haven’t done so already. Determine where ICD-9 codes currently appear in your systems and business processes. Budget for training, re-printing of superbills, etc. Finally, develop an ICD-10 timeline - all good first steps to help you prepare. Don’t forget to evaluate all vendor and payer contracts and upgrade as needed. The CMS website features a Provider Resources page for ICD-10 that includes factsheets, timelines, and additional resources to assist you with the transition to ICD-10 codes. The slides from the May 18 ICD-10 National Provider Teleconference are available online. Please visit cms.gov/icd10 to keep up to date and help prepare for Version 5010 and ICD-10. |
May 2011 Regulatory Round-Up Extra |
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Improvements to Medicare are Lowering Costs, Improving Care… An analysis issued by CMS outlines savings resulting from improvements to the Medicare program, including implementation of many provisions in the Affordable Care Act, from new tools and resources to help crack down on fraud, waste, and abuse in the Medicare system, to reforming payment systems to reward high quality care. The report outlines these provisions, finding that they will save nearly $120 billion for Medicare over the next five years. For the full report, please visit the CMS website. |
May 2011 Regulatory Round-Up Extra |
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NOE Error Code E9351 Update… On Notice of Elections (NOEs) for types of bill 81A and 82A, hospice providers are not able to access the NPI field for the OTH PHYS line on Fiscal Intermediary Shared System (FISS) claim Page 03 and are therefore unable to enter the necessary information. Affected claims are being held in status/location S M9001 with reason code E9351. CMS reports that a system fix will be implemented in December 2011. CMS has told all the contractors it is acceptable for providers to blank this field out and not submit the data, until the fix. |
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OIG Issues Report About CMS HIPAA Oversight… The OIG issued a report citing that CMS’s oversight and enforcement actions were not sufficient to ensure that covered entities effectively implemented the 1996 HIPAA Security Rule. There is limited assurance from CMS that controls are in place to secure electronic protected health information (ePHI), leaving ePHI vulnerable to attack and compromise. Both the Social Security Act and the Security Rule require a covered entity, such as a healthcare provider, that transmits any electronic health information, to: (1) ensure the confidentiality, integrity, and availability of the information; (2) protect against any reasonably anticipated threats or risks to the security or integrity of the information; and (3) protect against unauthorized uses or disclosures of the information. The OIG recommended that the HHS’s Office for Civil Rights continue the compliance review process and implement procedures for conducting compliance reviews to ensure that controls are in place and operating as intended. Review the complete OIG report online. |
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OIG Medicare Fraud: Download Compliance Training Materials… The OIG hosted the HEAT Provider Compliance Training HHS on Wednesday, May 18, 2011 about the realities of Medicare fraud and the importance of an effective compliance program. The slide presentation and written materials are posted in 13 PDF files on the OIG website. A video of the training is available for online. |
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OSHA Recordkeeping Rule Update…The OSHA Recordkeeping Adviser is a new Web tool that helps employers understand their responsibilities to report and record work-related injuries and illnesses under the Occupational Safety and Health Administration’s regulations. A set of questions assists in determining quickly whether an injury or illness is work-related, whether it needs to be recorded and which provisions of the regulations apply. |
May 2011 Regulatory Round-Up Extra |
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Region C RAC Lists Two Hospice Related Audit Items… Connolly, the Recovery Audit Contractor (RAC) for Regions C has listed two hospice related approved audit items. While hospice providers will not be audited directly, DME vendors and physicians who interact with hospice providers may potentially be audited for these issues. The approved issues are listed below: DME while in Hospice - Services related to a Hospice terminal diagnosis provided during a Hospice period are included in the Hospice payment and are not paid separately. Additional information can be found in the following manuals/publications:
Hospice Related Services: Part B - Services related to a Hospice terminal diagnosis provided during a Hospice period are included in the Hospice payment and are not paid separately. Additional information can be found in the following manuals/publications:
Visit the Connolly website to review all Connolly’s CMS-approved audit issues. |
Member inquiries about regulatory and compliance issues may be sent via email to regulatory@nhpco.org.
