Home Health & Hospice Week

Refer matching errors with 2020 ‘From’ dates to your MACs.

As more and more final claims are hitting snags under the Patient-Driven Groupings Model, more and more cash is being held up.

As expected, HHH Medicare Administrative Contractors began processing PDGM Requests for Anticipated Payment and claims in mid-January, noted a Centers for Medicare & Medicaid Services official in the agency’s Feb.26 Home Health Open Door Forum. But many of those claims have been returned due to a missing corresponding OASIS file.

In the beginning, many OASIS matching problems were due to implementation of the new Internet Quality Improvement and Evaluation System (iQIES) on Jan.1 and related bugs causing OASIS submissions to be unsuccessful. But most of the iQIES problems are now fixed, the CMS staffer maintained.(See a list of iQIES known problems and their resolutions at https://iqies.ventera.com).

CMS is in the process of trying to figure out if OASIS matching problems still exist, or if claims are getting Returned to Provider (RTP’d) due to user error such as having different data in fields required to match: M0010 (CMS Certification Number), M0062 (Medicare Number), M0090 (Date Assessment Completed), and M0100 (Reason for Assessment), the CMS speaker noted.

Watch for: CMS plans to put out an MLN Matters article detailing the steps home health agencies should take when they receive an RTP’d claim with reason code 37253, the CMS source said. (See coverage of a similar article from MAC CGS in Eli’s HCW, Vol. XXIX, No. 3.)

Meanwhile, multiple callers reported that problems continue in this area. One provider noted that when they show that a claim’s matching OASIS file has been accepted with a final validation report and they have all the required items matching between the claim and OASIS file, their HHH Medicare Administrative Contractor says it’s an iQIES issue and to watch the iQIES log for more information.

Response: CMS is researching such problems and trying to determine if such errors are actually occurring and if so, whether they are on the iQIES or payment system side, the staffer confirmed. That research is ongoing, he said.

A related error is causing claims without a matching OASIS to suspend rather than RTP, the CMS source added.A fix for that problem is scheduled for March 2.

Other home health topics addressed in the forum include:

• PDGM glitches. Aside from the OASIS matching problem, a few other issues are also affecting claims under the new payment system.

For example: There may be a pricing error, the CMS staffer acknowledged. There’s a delay to pricer software. And a new FISS screen that was supposed to be available to HHAs under PDGM is delayed until July 6. Currently only MACs can view the screen. (See more details about what’s on the new screen in Eli’s HCW, Vol. XXVIII, No. 30.)

• BFCC-QIO decision delays. Software problems aren’t exclusive to PDGM. Technical problems are delaying appeals decisions from Beneficiary and Family-Centered Care — Quality Improvement Organizations, a CMS staffer reported in the forum.

Multiple providers asked questions in the forum about the delays’ impacts, and CMS referred the questions to a new address: qioconcerns@cms.hhs.gov. Providers should send cases needing urgent decisions to this address, the CMS source instructed.

• PDGM education articles. CMS reviewed its articles informing physicians to furnish adequate diagnosis coding information to HHAs (see Eli’s HCW, Vol. XXVIII, No. 43) and telling HHAs not to arbitrarily cut therapy utilization (see Eli’s HCW, Vol. XXIV, No. 6). The articles are at www.cms.gov/files/document/se19027.pdf and www.cms.gov/files/document/se20005.pdf.
• CAHPS. If you want an exemption from the CAHPS data reporting requirement due to size in 2021, you must turn in your exemption form by March 31, a CMS staffer reminded forum attendees.

Also: If you’ve fallen off the CAHPS data reporting wagon — or never got on in the first place — now’s a great time to climb aboard. The new data reporting year starts April 1, and will impact payment rates for calendar year 2022, a CMS representative noted in the forum.

• HH Compare. Don’t forget that come April, Home Health Compare won’t report Improvement in Pain Interfering with Activity (NQF #0177) data any longer, a CMS official noted.CMS will eliminate the underlying OASIS question, M1242 (Frequency of Pain Interfering with Patient’s Activity or Movement), in OASIS-E that takes effect next January (see Eli’s HCW, Vol. XXVIII, No. 41).
• HHQRP. You can reference updated Quick Reference Guides for 2021 and 2022 Home Health Quality Reporting Program requirements in the “Downloads” section at www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/Spotlight-and-Announcements.

You can also access updated information for various HHQRP help desks at www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment- Instruments/HomeHealthQualityInits/Help-Desk.