CMS Updates - Home Health

CMS issues final rule on provider identification number 

Providers and suppliers who submit claims to Medicaid and Medicare must include an identification number on enrollment applications and payment claims, according to a final rule.

In a regulation that's effective June 26, the inclusion of a National Provider Identifier — which is a 10-digit provider identification number — will save Medicare $1.6 billion over 10 years, the Centers for Medicare & Medicaid Services estimates. The NIP, which also is required in HIPAA transactions, is used to verify certification as a means of curbing Medicare and Medicaid fraud and abuse.

While most providers already have an NPI, CMS said the savings estimate was calculated based on that a small number of patients would go to doctors without enrollment numbers, and therefore won't receive referrals for items like durable medical equipment.

Click here to read the full rule.

 

CMS Names Top 10 Survey Deficiencies

During the National Association of Home Care and Hospice’s (NAHC) March on Washington and Law Symposium, CMS representatives took part in a panel to discuss regulatory and policy initiatives. Key points discussed included payment policy, survey and certification, and medical review activities in homecare.

Of particular interest to us was that according to a CMS representative, the top 10 home health survey deficiencies, with their associated G-tags, are:

• Written Plan of Care established & periodically reviewed (G158)
• Plan of Care covers diagnosis, required services, visits, etc. (G159)
• Record with past/current findings maintained for all patients (G236)
• Assessment includes review of all medications (G337)
• Compliance with accepted professional standards/principles (G121)
• Supervisory visits if skilled care no less than once every 2 weeks (G229)
• Coordination of Patient Services (G143)
• Skilled Nursing Services furnished in accordance with Plan of Care (G170)
• RN prepares notes, coordinates, informs MD, other staff of changes (G176)
• Drugs and treatment administered only as ordered by physician (G165)

Most of these deficiencies are not a surprise to homecare providers. For example, plan of care deficiencies have long been prevalent in homecare. The most troublesome thing is that many of these top 10 deficiencies are repeated, or recurrent, and can be prevented. This is further validation that agencies must put compliance with the Conditions of Participation on their priority list sooner rather than later.

From the MLN: “Home Health Prospective Payment System” Fact Sheet Revised - The “Home Health Prospective Payment System” fact sheet (ICN 006816) has been revised and is now available in downloadable format. It includes the following information: background, consolidated billing requirements, criteria that must be met to qualify for home health services, coverage of home health services, elements of the HH PPS, updates to the HH PPS, and healthcare quality.

 

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