Tag Archives | CMS

PEPPER Data- The Free Comparative Billing Report You Need!

The RELI Group, along with its partners TMF Health Quality Institute and CGS, is contracted with the Centers for Medicare & Medicaid Services to develop, produce and disseminate provider-specific comparative data reports, referred to as the Program for Evaluating Payment Patterns Electronic Report, or PEPPER. PEPPER summarizes one provider’s Medicare claims data statistics and provides comparative […]

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No MBI = No Payment

No MBI = No Payment   As of January 1, 2020, all Medicare home health and hospice claims must include new Medicare Beneficiary Identifiers (MBI), regardless of the date of service. Claims without MBIs will be rejected. In a recent Provider Outreach and Education call for hospices, NGS reported that about 30% of New England […]

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PDGM. Here we go!

CMS issued its final rule for the 2020 payment model, PDGM, on October 31. It included rates of payment that go into effect on January 1, 2020. The final rule offered some minor tweaks to the payment model and set out 2020 payment rates. The rule includes a 4.36 percent cut (which CMS refers to […]

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CMS Issues New FAQs on Medicare Conditions of Participation

CMS Issues New FAQs on Medicare Conditions of Participation The Center for Medicare and Medicaid Services sent State Survey agencies a new “Frequently Asked Question” memo regarding the home health Interpretive Guidelines for the CoPs that went into effect in January 2018. The 10-page document covers questions regarding physician orders, home health aide competency and […]

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(recording) Under the Wire: OASIS D Training

The proposed updates to the OASIS item set, referred to as the OASIS-D, was posted by CMS today in accordance with the Paperwork Reduction Act (PRA) requirements.  This proposed revised OASIS item set is scheduled for implementation on January 1, 2019. 

Accurate data collection is vital to the success of any home health agency. This is especially the case since financial and clinical outcomes are calculated from the OASIS Assessment. Keeping up with OASIS changes can be overwhelming, but it is essential for your agency’s success!  Be sure your clinicians are prepared and proficient in current OASIS clinical practices with this last minute additional training for OASIS-D.




This is it! The changes are here! How you respond will determine how you are paid.  Agencies that invest in education and implementation of these changes will see the impact in their bottom line, truth is those who do not make that investment will too.  BE ON TOP OF YOUR GAME, with this just in time education program! Join Kathy Roby, Senior Health Care Consultant at Qualidigm for this in depth look at the OASIS D changes effective Jan 1, 2019.


Thursday Jan 3, 2019: An Overview of changes to the OASIS Data Collection Tool from OASIS C2 to the new OASIS D.  A focus will be on the rationale behind these changes and significance of each.


Tuesday, Jan 8, 2019: Review the new GG elements.  The queries will be reviewed with emphasis on their content, rationale, use, definitions, etc., with practice scenarios.  The link between these elements new to home health and how they are used will be discussed.


Thursday, Jan 10, 2019: Focus on the J elements (content, rationale, use, definitions, etc., with practice scenarios) and other additional changes that will be seen in the new tool.  This session will also conclude with a review of those more critical Q&A posted by CMS relating to these changes.


Continuing Education: 

RNs and LPNs must participate in the entire presentation for contact hours to be awarded. To apply for nursing contact hours, please mail an evaluation form and a completed sign-in sheet, listing the individuals at your facility that participated and noting those requesting contact hours.



Kathryn Roby is a Senior Consultant for Home Health Care at Qualidigm and focuses on improving home health provider clinical outcomes and reducing acute care hospitalizations.  As a dedicated educator, Ms. Roby has taught at the collegiate level, at the state level and the national level with a focus on quality management and improving quality of care outcomes.  Kathryn holds a M.S. in Health Care Administration from the Hartford Graduate Center, a M.Ed. from University of Saint Joseph, and a B.S.N. from the University of Connecticut. She is a Certified Home & Hospice Care Executive (National Association for Home Care) and a Certified Trainer for Integrated Chronic Care Management.


Charlotte Steniger is a Consultant at Qualidigm and has over 18 years of professional experience in the home health care industry as a nurse case manager and clinical educator. Ms. Steniger works directly with home health care agencies, evaluating their compliance with state and federal regulations, and providing recommendations to improve clinical processes. She has been a certified OASIS Specialist – Clinical since 2006.  Ms. Steniger is a Registered Nurse and holds an MSN in Nursing Education from the University of Hartford.


Registration Fee:

Member rate is $399.00 – Non-members $599.00


Know what you need. Know what you don’t need:

CMS has decided that factors not meeting the below criteria will no longer be collected:

  • Items used to calculate a measure finalized for the Home Health Quality Reporting Program (HH QRP) in the Home Health Prospective Payment System (PPS)
  • Items used in the survey process for Medicare certification
  • Items used to calculate a measure in the Home Health Value-Based Purchasing (HH VPB) demonstration
  • Items used as a critical risk-adjustment
  • Items incorporated into the OASIS to fulfill a data category as part of the Conditions of Participation in the CY 2018 Home Health PPS proposed rule

All of the recordings will be available through February 28,2019

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Summit on PDGM Coming to Boston this March

NAHC To HOST NATIONAL SUMMITS:Preparing Home Health Agencies for 2020 and Beyond Medicare Patient-Driven Groupings Model: A Revolution in Medicare Home Health Payment One-Day Intensive Educational Summits JANUARY – MARCH 2019  |  12 STRATEGICALLY LOCATED CITIES ACROSS THE COUNTRY  The most consequential changes to impact home health in decades are coming in 2020 — are […]

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Fixing PDGM

Despite opposition from the home health industry, CMS included a “behavioral assumption” reduction in its final proposal to move to a Patient-Driven Groupings Model in 2020. The reduction is expected to decrease Medicare home health payments by over a $1 billion. Several bills have been introduced in Congress to stop the behavioral assumption and require […]

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CMS Clarifies NWPT, Outlier Payments, and Updates Medicare Benefit Policy Manual for Home Health

Last week, CMS issued Change Request 9898, transmittal #233.  All Medicare-certified agencies should review this document.  It clarifies the payment policy changes for Negative Pressure Wound Therapy (NWPT) using a disposable device, and also clarifies the methodology to calculate outlier payments for home health.  The implementation date is March 27, 2017. In addition, the CR […]

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CMS Billing Clarification

Last week, CMS issued the CY 2017 Medicare Home Health Prospective Payment System Final Rule. Overall, CMS estimates a 0.7% reduction in Medicare home health payments ($130 million in 2017 nationally.) Here are the ingredients: A market basket update of 2.5%  (a $450 million increase) A 0.97% reduction in the national, episodic base rate due […]

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CMS Publishes Final Rule for 2017 Medicare Home Health Rates

Yesterday, October 31st, the Centers for Medicare and Medicaid Services (CMS) announced its final rule regarding changes to the Medicare home health prospective payment system (HHPPS) for Calendar Year (CY) 2017. The final rule also includes payment policy provisions, updates to the home health quality reporting program (HHQRP) and proposed changes to the Home Health […]

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CMS Proposed & Finalized Rules, Drug Price Updates

On July 25, 2016 CMS released the Advancing Care Coordination proposed rule. Looking to the aim of CMMI to test innovative payment and service-delivery models to reduce expenditures while preserving or enhancing the quality of care, the proposed rule targets the Medicare Program introducing three new episode payment models (EPMs), a Cardiac Rehabilitation (CR) Incentive Payment Model, […]

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CMS Solicits Comments on Data Items Under the IMPACT Act

The Centers for Medicare and Medicaid Services (CMS) is soliciting for public comment on a collection of standardized assessment-based data items developed under the Improving Medicare Post-Acute Care Transformation Act (IMPACT Act) of 2014 to meet the domains of cognitive function and mental status; special services, treatments, and interventions; medical conditions and co-morbidities; and impairments. […]

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CMS Issues Call for Technical Experts on Quality Measures

The Centers for Medicare and Medicaid Services (CMS) is currently soliciting nominations for technical expert panel members for quality measures developed under the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act) to meet the domain of the transfer of health information and care preferences. CMS is seeking technical experts with expertise in care […]

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CMS Expands List of Manifestation Codes under ICD-10 Effective 10-1-16

This week, the Centers for Medicare & Medicaid Services (CMS) issued Change Request 9754/Transmittal 3591, the October 2016 Integrated Outpatient Code Editor (I/OCE) Specifications Version 17.3. The document provides updates for the I/OCE that will be applicable for various Medicare services beginning October 1, 2016. Among the changes included in the transmittal is a list […]

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Billing for Nursing Visits in Home Health Shortage Areas by an RHC or FQHC

Section 1861(aa)(1)(C) of the Social Security Act authorizes Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) located in areas with a shortage of home health agencies to furnish part-time or intermittent nursing care and related medical supplies (other than drugs and biologicals) by a Registered Professional Nurse (RN) or Licensed Practical Nurse (LPN) […]

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Medicaid Adopts New Home Health Rules; F2F Requirement Delayed Until September 1

NH Medicaid adopted new Home Health Services Rules on July 1.  The He-W 553 rules include eligibility requirements, provider requirements, covered and non-covered services and documentation requirements.  The rules had been in the process of being revised since last fall and HCANH provided detailed written comments on multiple drafts.  There are two major changes which […]

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Hospice CAHPS® Exemption for Size Deadline: August 10

The application deadline for a size exemption from the Hospice CAHPS Survey is August 10, 2016. For the CY 2016 data collection period, Medicare-certified hospices that served fewer than 50 survey-eligible clients in CY 2015 can apply for exemption from the CAHPS Hospice Survey. Exemptions on the basis of size are active for one year […]

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Update on Face to Face

On November 6, 2014, The Centers for Medicare & Medicaid Services (CMS) issued final rule CMS-1611-F, Calendar Year (CY) 2015 Home Health Prospective Payment System (HH PPS) Final Rule.  The HH PPS final rule (79 FR 66032) finalized a change that, beginning, January 1, 2015, requires home health agencies (HHA) to obtain documentation from the […]

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More Clarifications for ICD-10 Change

The National Association for Home Care & Hospice (NAHC) has recently learned that the organizations responsible for the official ICD-10 coding guidance has issued clarification that would require home health agencies to indicate an “A” (initial encounter) in the 7th character for some ICD-10 codes. An “A” in the 7th character should be used for any encounter […]

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