Home Health & Hospice Week

Seventh characters, star ratings also addressed in Open Door Forum.

Episodes that could have claims spanning Jan. 1 already have started, and home health agencies want to know how to handle coding for nursing visits in light of the new G-codes taking effect in the New Year.

Reminder: As part of hospice payment reform, nursing G-codes are being split into RN and LPN categories (see more about the codes in Eli’s HCW, Vol. XXIV, No. 38). HHAs must use the new codes too.

As Medicare Administrative Contractors have been telling agencies (see Eli’s HCW, Vol. XXIV, No. 39), agencies can use both the old nursing G-code (G0154) and the new G-codes for RN visits (G0299) and LPN visits (G0300) on the same claim. Report G0154 for visits provided through Dec. 31, and the applicable new codes for visits provided Jan. 1 or later, Wil Gehne with the Centers for Medicare & Medicaid Services instructed in the Nov. 4 Open Door Forum for home care providers.

Clarification: Agencies and vendors also have been asking about how the new G-codes affect reporting of other nursing HCPCS codes G0162 (RN management and evaluation), G0163 (RN or LPN observation and assessment), and G0164 (RN or LPN training/education). “The short answer to that is that there is no effect,” Gehne told agencies. HHAs “should continue to report those three codes in the same way that they have previously,” he advised in the forum.

Other home care topics addressed in the forum include:

• Seventh character. In the 2016 final rule, CMS said it is restoring reimbursement for certain ICD-10 codes with an “A” as the seventh character (see Eli’s HCW, Vol. XXIV, No. 40). CMS has posted its updated ICD-10 Translation List, including applicable “A” codes, noted CMS’s Kristine Leddy. The list is in a link to a ZIP file under the “Billing/Payment” heading at www.cms.gov/center/provider-Type/home-Health-Agency-HHA-Center.html.

CMS is revising the HH PPS Grouper to include the codes retroactive to Oct. 1. But when the new grouper takes effect, it will be up to you to go back and claim your rightful reimbursement, Gehne clarified in response to a question from a caller.

Take action: Each agency can check if the coding changes resulted in any HIPPS code changes, he advises. Then it’s the agency’s responsibility to adjust its claims for revised HIPPS code, if it wishes.

• Star ratings. The next update for your quality star rating on Home Health Compare will be Jan. 21, noted CMS’s Theresa White. Home health agencies received their preview reports for the ratings last month (see Eli’s HCW, Vol. XXIV, No. 36).

The star ratings are relatively new, and CMS will conduct a review of your rating upon request. However, be aware that CMS is shooting down requests for suppression based on clinicians inaccurately answering OASIS items, White said in the call. “The conditions of participation require accurate data submission and agencies can, and should, be monitoring clinician understanding of data collection requirements,” she exhorted.

Valid reasons for suppressing star ratings do exist, though, White acknowledged. For example, a software error leading to inaccurate data may be valid grounds for suppression for one quarter, if the agency has a plan to correct the glitch.

Tip: HHAs can use the reports in the QIES system to identify star rating problems early, White suggested. “Routinely review these reports and then investigate measures” that have low or questionable scores, she said. “By doing so, agencies can proactively correct issues that are within their control and may positively impact their … star ratings.” The reports are updated monthly.