Home Health & Hospice Week

Plus: CMS withdraws erroneous hospice certification guidance.

A burdensome new requirement announced last month seems to have gone as quickly as it arrived.

Then: On May 14, HHH Medicare Administrative Contractor Palmetto GBA issued a “Home Health Review Choice Demonstration Certifying Provider Change,” which said that “beginning May 20, 2024, home health agencies must submit a hand-off from any original certifying provider to a subsequent provider.” Multiple industry experts expressed confusion about the new requirement and questioned its validity (see HHHW by AAPC, Vol. XXXIII, No. 18).

Now: After industry representatives including the National Association for Home Care & Hospice questioned the Centers for Medicare & Medicaid Services about the matter, Palmetto has withdrawn the new mandate, including removing its article announcing the change.

“There is not a requirement for a physician-signed ‘hand off ’ under any circumstance in home health,” NAHC says in an update. In an early June meeting, Palmetto GBA and CGS representatives “confirmed that they are not applying the ‘hand off ’ requirement as part of RCD or medical review of claims,” the trade group says.

Watch for: CMS and Palmetto have “indicated that all MACs will be posting a revised article,” although it lacks an ETA, NAHC adds.

Do this: “Home health agencies that have had claims denied due to the lack of a ‘hand off ’ should appeal those denials,” NAHC counsels. “Likewise, home health agencies participating in the pre-claim review option for RCD that have had non-affirmations for this reason, should submit the Document Control Number (DCN) to PalmettoGBA for correction,” the trade group adds.

Medicare Pulls Contradictory Guidance

In another win on the advocacy front, CMS has withdrawn its guidance saying that any individual who elects to receive hospice services in a subsequent hospice election would need to be certified as if entering hospice in the initial benefit period, NAHC and the National Hospice and Palliative Care Organization report. CMS had issued that incorrect information in a Hospice Certifying Enrollment Questions and Answers document, NAHC reminds. CMS implemented a new certifying physician edit on June 3.

The previously announced policy “contradicted Section 1814(a)(7) of the Social Security Act (SSA) and regulations at 42 C.F.R. § 418.22(c)(2). The SSA and regulations indicate that the attending physician must only certify a patient’s terminal illness for the initial hospice Medicare benefit period; and that only one physician, not both the attending and hospice physician, must provide this certification for subsequent benefit periods,” NAHC maintains.

“Considering the staffing constraints many providers currently face, this clarification frees up both operational and physician resources to be best allocated to delivering the highest-quality care to patients and families,” NHPCO’s Ben Marcantonio says in a release.

“Rescinding the instruction … has alleviated confusion in the industry and avoids disruptive negative impacts,” praises NAHC President William Dombi in the release.