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To combat improper billing, the Centers for Medicare & Medicaid Services (CMS) in 2016 rolled out the controversial pre-claim review demonstration in Illinois, an initiative that required home health providers to send in their claims earlier in the care process. With the help of Congress, however, stakeholders were able to seemingly stop pre-claim review dead in its tracks. Click HERE to read full article.

An opinion piece authored by William A. Dombi, President of the National Association for Home Care & Hospice (NAHC), and Keith Myers, Chairman of the Partnership for Quality Home Healthcare, calls on Congress to stop implementation of the Patient Driven Groupings Model (PDGM), a controversial program by the Centers for Medicare & Medicaid Services (CMS) that relies on unproven assumptions to reduce payments to home health providers.

Just as home health care is becoming more popular than ever due to increasing public awareness of its ability to deliver first-class health care at a fraction of the cost in institutional settings, the CMS plan threatens to disrupt care for 3.5 million homebound seniors who want only to manage their medical conditions in their own homes. Click HERE to read full article.

In response to the fires in Butte, Los Angeles and Ventura counties, the Department of Health Care Services (DHCS) has issued the following information about the need to dispense replacement medication to beneficiaries impacted by these fires.

Pharmacies are advised to submit a Treatment Authorization Request (TAR) using the Special Handling of “Six Prescription Limit” and incorporate the statement “Patient impacted by [identify specific county] county fire” within the Miscellaneous Information field on the TAR. Click HERE to read full article.

The HIS Manual has been updated with refined guidance for completing the HIS based on frequently asked questions from the Hospice Quality Help Desk. Note that no updates were made to HIS items or the HIS itself (i.e., no HIS items have been added, deleted, or changed). Instead, additional guidance based on provider feedback from the Hospice Quality Help Desk has been added to the manual to clarify HIS coding instructions. Click HERE to read full article.

CMS is working hard to collect feedback and update policies for Medicare and Medicaid that are outdated, duplicative, or overly burdensome. Here are a few of the changes:

  • Earlier this year, CMS changed the policy so that medical student's patient notes can be now used for billing purposes after the physician signs off.
  • In the 2019 proposed rule for the Physician Fee Schedule, CMS will simplify the documentation of history and exam, eliminate the requirement for documenting the medical necessity of furnishing visits in patient's home, and remove potentially duplicative requirements for certain notations in medical records among other things.

Click HERE to read full article.

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