Home Health & Hospice Week
TPE Torpedoes Hospices — Again
Unsupported terminal prognosis causes most denials. One HHH Medicare Administrative Contractor racked up another 100 percent failure rate for hospices under Targeted Probe and Educate medical review in the latest quarter. In the three months ended Dec. 31, 2018, MAC CGS completed seven TPE probes. They were all under the Length of Stay with Non-Oncologic Diagnosis edit (5D000). CGS medical reviewers found all seven hospices non-compliant, advancing them to round 2 of TPE. One of the hospices did not respond to Additional Development Requests for round 1, the MAC notes in an article updating its TPE results. “Terminal prognosis not supported” accounted for about 84 percent of the total TPE denials, CGS says. The second-most-common reason for denials, “subsequent certification not timely,” was well behind at about 4 percent of the total hospice TPE denials. See the results at www.cgsmedicare.com/hhh/pubs/news/2019/0119/cope11067.html.
Home Health & Hospice Week
- Patient-Driven Groupings Model:
HHAs Start Their Engines For Runup To PDGM
Thirty-day billing period base rate 55.6 percent of 60-day rate. It soon will be time [...] - Legislation:
Resistance Continues Against Behavioral Adjustment Cut
HHAs have only months to secure legislative change. The home health industry is fighting to [...] - Reimbursement:
Keep These Top Changes In Mind As PDGM Nears
Beware LUPA dangers. As you navigate the murky Patient-Driven Groupings Model waters, you’ll have to [...] - OASIS:
These 8 Items Will Help Determine Your PDGM Pay
2 items debut as case mix factors. Familiarize yourself with the OASIS items that will [...] - Billing:
CMS Starts Its RAP Phase-Out
Plus: Learn about these new occurrence codes that can bring you higher reimbursement. Your billing [...] - Payment:
PDGM HIPPS Code May Not Mean What You Think It Means
Get to know the new code. Whether you know the current HH PPS HIPPS codes [...] - Patient-Driven Groupings Model:
Use These Guidelines To Plan Your PDGM Launch Date
Episodes spanning Jan. 1 get 60-day rate. You should be starting your ramp-up to the [...] - Hospice:
Visits When Death Imminent Measure Closer To Going Public
HEART, public reporting also addressed. Competitors, referral sources, and others will soon get a look [...] - Regulations:
Home Health Compare Looks Different
Education on OASIS-D continues. More than just your data looks new on the Home Health [...] - Industry Note:
TPE Torpedoes Hospices — Again
Unsupported terminal prognosis causes most denials. One HHH Medicare Administrative Contractor racked up another 100 [...] - Industry Note:
MBIs Now Used On Nearly Two-Thirds Of Claims
The percentage of claims using beneficiaries’ new MBI numbers continues to grow. For the week [...] - Industry Note:
Hospice Forks Over $27K CMP For Excluded Employee
Make your employee background checks a priority, a recent HHS Office of Inspector General notice [...]
