Text Size

  • Increase
  • Decrease
  • Normal

Current Size: 100%

NHPCO Regulatory Round-Up April 2011

NHPCO Regulatory Recap for Activity from April 2011

Volume 1, Issue No. 4

To:       NHPCO Membership

From:   NHPCO Regulatory Team

Re:       May 17, 2011

[Download PDF Version]

This issue of NHPCO’s Regulatory Round-Up contains the hot issues from April, 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:

Regulatory Round-Up Extra:  April, 2011

  • Certification and Recertification of Hospice Terminal Illness resource is a laminated pocket guide that describes the certification and recertification process, with special attention given to the face-to-face encounter requirement. Offering maps and tables designed to guide the admission team, hospice physician, or nurse practitioner through the process of certification and recertification, no matter what benefit the patient is in.  Certification and Recertification of Hospice Terminal Illness was unveiled at MLC’s Marketplace and the supply onsite sold out within three days. Place your order with Marketplace today.

   

Originally published: April 14, 2011 NewsBriefs.

  • CMS Proposed FY2012 Wage Index…. CMS posted the FY2012 Hospice Wage Index proposed rule late Thursday April 28, which includes wage index information  as well as clarifications on the face to face requirement, discussion of cap calculation methodologies and the ability of the hospice to choose between the current methodology and a patient-by-patient proportional methodology.  In addition, the proposed rule discusses the FY2014 requirement that hospices begin publicly reporting quality measures and how CMS proposes to begin that process.  The proposed rule can be viewed in its entirety in PDF on the Federal Register website.  The NHPCO Regulatory Alert (04/29/11) is available online. Originally published: April 21, 2011 NewsBriefs.  
  • CMS Releases Ruling on CAP… Over the past couple of years, some hospice programs have filed lawsuits challenging the CAP calculation regulation.  In light of these cap cases, most of which have been resolved in favor of the hospices, CMS has ruled that all currently pending appeals that are challenging the validity of 42 CFR 418.309(b)(1) will be remanded to the applicable Medicare contractor for recalculation of the hospice’s cap using a patient-by-patient proportional methodology.  So each  beneficiary who received care in a cap year will be allocated to that hospice on the basis of a fraction, account for the portion of their overall hospice stay that occurred in that cap year.  CMS acknowledges that at the time of the calculation the beneficiary may still be receiving care and therefore the proper allocation of the patient between multiple cap years may not be completely accurate, but the contractors are instructed to use the best data available and not wait until all patients have died or otherwise left hospice care.  The determinations will be subject to reopening, so if the hospice later wants to go back and have the cap recalculated using final data that wasn’t available at the time of the initial calculation, they may do so.  For hospices that have not filed administrative appeals challenging the cap calculation methodology, CMS will continue using the current methodology set forth in the hospice regulations unless CMS adopts something different pursuant to the hospice wage index rule for FY 2012.  The Ruling also states that in the FY 2012 hospice wage index proposed rule, they are proposing to revise the cap calculation regulation to provide for application of a patient-by-patient proportional methodology for cap years 2012 and beyond, or allow the provider to choose to have the current methodology set forth in the regulations be used to make the cap calculation. The ruling (CMS-1355-R) is available on the CMS website. Originally published: April 28, 2011 NewsBriefs.  
  • HIPAA 5010 Implementation Items... Reminder – 5010/D.0 Errata requirements and testing schedule Reminder – Contact your MAC for their testing schedule Readiness Assessment – Have you done the following to be ready for 5010/D.0? Readiness Assessment – What do you need to have in place to test with your MAC? Readiness Assessment – Do you know the implications of not being ready? May 2011 (2, 5, and 25) – 20th Annual WEDI National Conference*  CMS-hosted Medicare FFS National Call – Call to Action - Test Originally published: April 7, 2011 NewsBriefs.  
  • Going Beyond Diagnosis in Support of Care Coordination…The latest Going Beyond Diagnosis (GBD) blog post contains a GBD case study and table illustrating the value of using the categories contained in the International Classification of Functioning Disability and Health (ICF) to help organize and communicate patient-centered functional status information (FSI). Regulatory Round-Up Extra:  April, 2011  
  • MAC Jurisdiction 15 Update… CIGNA Government Services’ first ACT (Ask the Contractor) call is devoted to HH+H providers who currently submit their claims to Cahaba GBA. This is a provider’s opportunity to interact directly with the Subject Matter Experts at CIGNA Government Services to ask questions relative to the implementation of Jurisdiction 15. Representatives from Cahaba GBA will also be in attendance on the call. More information is available on the CIGNA website. Originally published: April 7, 2011 NewsBriefs.  
  • “Medicare Physician Fee Schedule” Fact Sheet Now Available in Print… The publication titled “Medicare Physician Fee Schedule” is now available in print format from the Medicare Learning Network®. This fact sheet is designed to provide education on the Medicare Physician Fee Schedule (PFS) including physician services, therapy services, Medicare PFS payment rates, and the Medicare PFS rates formula.  To place your order, visit the CMS website, scroll to “Related Links Inside CMS,” and select “MLN Product Ordering Page.” Regulatory Round-Up Extra:  April, 2011
  • Notes from Home Health, Hospice & DME/Quality Open Door Forum Call… CMS started the 04/13/11 call with a reminder that the delay of enforcement for the face-to-face encounter has ended and all re-certifications in the 3rd or later benefit period dated April 1, 2011 and going forward could be subject to medical review. CMS also made the following clarifications regarding the face-to-face encounter process:
    • Electronic physician/NP signatures are acceptable for the face-to-face encounter.
    • If the face-to-face encounter is not completed timely, the patient is not longer eligible for Medicare hospice services and hospice providers should follow the discharge process. When the face-to-face is completed, the patient is treated as a new admission and must complete all new admission forms and documentation for this patient.
    • CMS deferred clarification regarding the need for issuance of an ABN in this scenario citing that the CMS staff who are knowledgeable about the ABN were not present at the open door forum.
    • Finally, a provider reported that they cannot enter hospice Notices of Election because of dashes in the attending physician name and NPI number fields and there is no way to enter the data or submit the NOE. CMS acknowledged the issue and are currently researching the problem. CMS offer encore recording of all CMS Home Health, Hospice & DME/Quality Open Door Forum Calls online.  Originally published: April 14, 2011 News Briefs
  • NGS - Notices of Election Rejecting with Reason Code E9351 Description of the Problem Hospice notices of election (NOE) transactions require the attending physician and the OTH physician fields to be complete. However, since the implementation of the April system release, direct data entry (DDE) is not allowing/capturing the OTH physician National Provider Identifier (NPI); therefore, NOEs are rejecting with reason code E9351. What This Means to You This is a known issue. Until the issue is resolved, providers are advised to leave the OTHER PHYS NPI/LN/FN field on the NOE blank. The certifying physician information will be captured on the claim(s) that are submitted for the patient. Please follow the physician reporting instructions below to bypass this system issue. -  Notice of Election (TOB 8XA) Physician Reporting Instructions ATT PHYS NPI/LN/FN Field: Enter the NPI and the name of the attending physician designated by the patient at the time of election as having the most significant role in the determination and delivery of the patient’s medical care.       OTH PHYS NPI/LN/FN Field: LEAVE BLANK. If any dashes are present in any of the fields,        remove them before PF9’ing the claim.   -  Claim (TOB 8X1/8X2/8X3/8X4) Physician Reporting Instructions ATT PHYS NPI/LN/FN Field: Enter the NPI and the name of the attending physician designated by the patient at the time of election as having the most significant role in the determination and delivery of the patient’s medical care.       OTH PHYS NPI/LN/FN Field: Report the NPI and name of the hospice physician        responsible for certifying that the patient is terminally ill, with a life expectancy of six months or less if the disease runs its normal course. Current Status 04/26/2011: CMS has approved a workaround until the system issue is resolved.     Please follow the instruction above when submitting NOEs and claims until further notice. -  04/13/2011: This issue is being researched. Please watch the Latest Production Alerts    section of our Web site and our E-mail Updates for future updates. Regulatory Round-Up Extra:  April, 2011  
  • Palmetto’s Timely Filing Job Aid… The Timely Filing Job Aid was updated to include related information from Change Requests 6960, 7080 and 7270. This job aid also includes references from the Code of Federal Regulations (42CFR - Section 424.44) and the Patient Protection and Affordable Care Act (PPACA).  The Timely Filing Job Aid is available online. Originally published: April 14, 2011 NewsBriefs.
  • “Signature Requirements” Fact Sheet (New)… A new publication titled “Signature Requirements” is now available in downloadable format from the Medicare Learning Network®. This fact sheet is designed to provide education on Signature Requirements to healthcare providers, and includes information on the documentation needed to support a claim submitted to Medicare for medical services. Regulatory Round-Up Extra:  April, 2011

Medicare Administrative Contractors Training

 

CMS Hospice Related Questions and Answers

CMS new/updated hospice related Q&A’s, April 2011 (PDF)

 

 ###

Member inquiries about regulatory and compliance issues may be sent via email to regulatory@nhpco.org.