Home Health & Hospice Week

Plus: CMS didn’t address Pre-Claim Review in latest forum, but MAC offers resources.

If you’re confused about whether to put new 2017 therapy codes on your claim, you’re not alone.

The Centers for Medicare & Medicaid Services implemented CPT^® codes 97161 through 97168 for physical therapist and occupational therapist evaluations Jan. 1. In the MLN Matters article about the change issued last November, CMS said the information is “intended for physicians, therapists, and other providers … submitting claims to Medicare Administrative Contractors (MACs), including Home Health & Hospice MACs, for outpatient therapy services provided to Medicare beneficiaries.”

But the codes only apply to home health agencies when they submit claims for Part B therapy services, a CMS official clarified in the agency’s Feb. 8 Home Health Open Door Forum. When billing under the home health benefit using Type of Bill 32x or under the hospice benefit using Types of Bill 81x and 82x, don’t use these new therapy codes, he stressed. “The current instructions to use therapy G codes remain in place for those claims.”

HHAs would use the new codes only when “they’re separately billing Part B therapies that are not under a home health plan of care — that is when they’re using Type of Bill 34x,” the CMS staffer explained. “In that case, they would use the new codes in the same situation that they had been using the retired codes 97001-97004.”

The MLN Matters article is at www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9782.pdf.

Other home health topics addressed in the forum include:

• Pre-Claim Review. Although PCR was originally listed on the forum’s agenda, it was removed when the agenda changed at the last moment. That may be disconcerting for Florida HHAs, who are looking down the barrel of an April 1 implementation date for the demonstration project.

However: Florida MAC Palmetto GBA did offer a one-hour webcast on Feb. 12 providing “an overview of the PCR process, lessons learned from the Illinois implementation and how to submit a PCR request.” The MAC told agencies that “attend ing this webcast will ensure you are ready to begin submitting for the PCR demonstration.”

Palmetto is offering another webcast on PCR documentation requirements on Feb. 22. It will include “clinical examples of documentation to submit for PCR” and will show you “what documentation to submit and what the Palmetto GBA nurse reviewers are looking for to affirm your submission,” the MAC says. “Attending this webcast will assure you have a clear understanding of the PCR process,” Palmetto adds.

Agencies can access both on-demand webinars by going to www.palmettogba.com, clicking on “Jurisdiction M Home Health and Hospice” in the “Medicare Resources” box on the right, then clicking on “Home Health Pre-Claim Review” in the “Top Links” box, then clicking on “Self-Paced Learning” and choosing the webcast links listed Feb. 6.

• Star Rating Change. Don’t forget the chance to comment on changes to your Quality of Patient Care star rating ends Feb. 20. ACMS official reviewed the proposal to remove “Influenza Immunization Received for Current Flu Season” from the nine measures used in the star rating calculation and replace it with “Emergency Department (ED) Use without Hospitalization,” as the agency outlined in a Jan. 19 Special Open Door Forum on the topic (see Eli’s HCW, Vol. XXVI, No. 6).

You can submit your take on the changes to HH_QM_Comment@abtassoc.com by the deadline. CMS plans to hold an Open Door Forum on the topic March 17.

CMS is poised to move ahead quickly with the change, if it’s adopted, it signaled in the January forum. Agencies’ April QoPC preview reports could contain the new calculation, the agency said.

• Home Health Compare. The website’s data refresh on Jan. 26 is the first that reflects the quality measure removals finalized in the 2017 HH PPS final rule, a CMS staffer pointed out. CMS removed 34 measures from the site (see Eli’s HCW, Vol. XXV, No. 41).

Still around: While the measures were removed from the Compare site, they will still appear on agencies’ preview reports in the CASPER system “for another few refresh cycles due to production processes,” the CMS source explained.

Also: “Some providers may have noticed that the downloadable files that accompanied this refresh contained duplicate values for the patients’ survey ratings and the Quality of Patient Care star ratings,” she added. “This has been corrected and revised files are now available on HH Compare.” The data in the Jan. 26 refresh was available in preview reports via CASPER last October, she noted.