Compliance Monitor (9/30/2024)
CHAP is always seeking resources and insights to enhance the knowledge of partners and customers.
Be sure to download CHAP’s compliance calendars for home health and hospice.
Top Items
The Hospice Care Accountability, Reform, and Enforcement (Hospice CARE) Act
Representative Earl Blumenauer (OR-3) introduced the Hospice Care Accountability, Reform, and Enforcement Act (Hospice CARE Act). In addition, the representative published an overview and section-by-section summary.
Resources & Flexibilities to Assist with the Public Health Emergency in Louisiana
On September 12, 2024, Secretary Xavier Becerra determined that a public health emergency exists in Louisiana and has existed since September 10, 2024. CMS announced additional resources and flexibilities available in response to Hurricane Francine in Louisiana. CMS is working closely with the state to put these flexibilities in place to ensure those affected by this natural disaster have access to the care they need – when they need it most.
CMS stands ready to assist with resources and waivers to ensure hospitals and other facilities can continue to operate and provide access to care to those impacted by the consequences of the hurricane.
More Information:
- Current Emergencies webpage
Hospice Updates
Hospice Claims Edits for Certifying Physicians — Revised
CMS added an exception to the edit logic (PDF) for when a nurse practitioner or physician assistant is serving as an attending.
Expanded Prepayment Review of Existing Hospices in Arizona, California, Nevada, & Texas
Learn about the expanded prepayment review and related activities (PDF) for existing hospices in Arizona, California, Nevada, and Texas:
- What’s the goal and how this affects you
- What type of review we’ll perform
- How we’ll notify you
- When it starts
- Where to get more information
NOW AVAILABLE: Hospice Outcomes and Patient Evaluation (HOPE) final materials
The Hospice Outcomes and Patient Evaluation (HOPE) final materials are now available. Materials include the HOPE Guidance Manual v1.00, the Items sets (HOPE Admission v1.00, HOPE Update Visit (HUV) v1.00, HOPE Discharge v1.00 and HOPE ALL Item v1.00), and the HIS to HOPE v1.00 Change Table. All of these documents can be accessed from the Downloads section on the CMS HQRP HOPE webpage.
Additional HOPE related resources posted:
Hospice HOPE Tool Data Specifications
The technical data specifications will be available soon after the publication of the FY2025 Hospice Final Rule (CMS-1810-F). Regarding your EHR user interface, CMS does not provide guidance on what that interface should look like. CMS requires that the software complies with the final HOPE data specifications.
Hospice Quality Reporting Program (HQRP) September Forum Materials Available Now
On Wednesday, August 21, 2024, the Centers for Medicare & Medicaid Services (CMS) hosted the August 2024 HQRP Forum to provide information on the Fiscal Year 2025 Hospice Final Rule and additional HQRP updates. Materials from this HQRP Forum, including a recording of the presentation, are now available in the Downloads section of the Provider and Stakeholder Engagement page at: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Hospice-Quality-Reporting/Hospice-QRP-Provider-Engagement-Opportunities. A recording of the presentation is also available on the official CMS YouTube channel: https://youtu.be/eZcIlptDelA
2024 HQRP Quarter 2 Q&A
The HQRP Quarterly Q&A for Q2, 2024 is now available. This Q&A includes selected questions received by the Hospice Quality Help Desk during the second quarter of 2024 (Apr. 1 to June 30). A link to the document can be found in the Downloads section of the HQRP Requirements and Best Practices page.
Home Health Updates
Expanded HHVBP Model Web-Based Training: Changes to the Applicable Measure Set Beginning in CY 2025
The Centers for Medicare & Medicaid Services (CMS) is offering a web-based training course that provides an overview of changes to the expanded Home Health Value-Based Purchasing (HHVBP) Model applicable measure set for calendar year (CY) 2025 based on the Home Health (HH) CY 2024 Prospective Payment System (PPS) final rule. The course includes an overview of the changes to the expanded HHVBP Model applicable measure set categories, reflecting removed and added quality measures. A review of measure specifications and updated measure weighting is also provided. To directly access the training, click the following link: https://pac.training/courses/expanded_hhvbp_2025/#/ Or you can access the training on the Model’s web page.
Home Intravenous Immune Globulin Items & Services: CY 2025 Rate Update
The CY 2025 payment rate for Q2052 (Services, Supplies, and Accessories used in the Home for the Administration of Intravenous Immune Globulin) is $431.83.
Influenza Vaccine: Holding Claims for CPT Code 90658
CMS is aware of an issue affecting payment for CPT code 90658:
- Long descriptor: Influenza virus vaccine, trivalent (IIV3), split virus, 0.5 mL dosage, for intramuscular use
- Short descriptor: IIV3 VACCINE SPLT 0.5 ML IM
We’re holding claims for CPT code 90658 for dates of service on or after August 1, 2024, until October 7, 2024.
Your Medicare Administrative Contractor will reprocess any denied claims by November 1, 2024. You don’t need to take any action.
DME Updates
DMEPOS Fee Schedule: October 2024 Quarterly Update
Learn about fee schedule updates (PDF):
- Fee schedule amounts for new and existing codes
- Revised fee schedule amounts for A4271
All Provider Updates
CMS Optimizing Healthcare Delivery to Improve Patient Lives Conference
Registration is now open for the 2024 CMS Optimizing Healthcare Delivery to Improve Patient Lives Conference taking place on December 12, 2024, from 11:00 AM to 4:00 PM ET.
This free, virtual conference hosted by the Centers for Medicare & Medicaid Services (CMS) will convene change makers from the healthcare community and federal government to share new ideas, lessons learned, and best practices to reduce administrative burden and strengthen access to quality care.
CMS will share more details and the event agenda soon.
After registering, please look for a confirmation email from CMSOptimizingCareConference@rippleeffect.com. If you do not see it in your primary inbox, please check your spam/junk folder.
Help Reduce Health Disparities for Hispanic or Latino Patients
Hispanic Americans are at greater risk of various health conditions due to a lack of preventive care and language barriers. During National Hispanic Heritage Month, increase your awareness of health disparities and learn about culturally and linguistically competent health care.
More Information:
- Introduction to Language Access Plans web-based training
- Latino Partners webpage
ICD-10 Medicare Severity Diagnosis-Related Group Version 42
Get updated ICD-10 Medicare Severity Diagnosis-Related Group (MS-DRG) Classifications and Software. CMS posted Version 42:
- Grouper and Medicare Code Editor software: mainframe and PC
- Definitions Manual: text and HTML
Version 42 is effective for discharges on or after October 1, 2024.
Health Care Preparedness Resources
The Administration for Strategic Preparedness and Response’s Technical Resources, Assistance Center, and Information Exchange (ASPR TRACIE) released new and updated health care preparedness resources, which could help you comply with some of the CMS emergency preparedness requirements:
- Extreme Weather and Healthcare: Lessons Learned and Considerations for the Future The Exchange, Issue 19: highlights lessons learned and strategies for planning and responding to extreme weather hazards (for example, burns and other injuries related to extreme heat, flooding, utility outages, and other infrastructure failures)
- Workplace Violence Considerations Speaker Series: features presentations from facility staff discussing their experiences with armed assailant planning and incidents
- Volunteer Management Topic Collection: includes resources to assist health care facilities with incorporating volunteers into their disaster management plans
More Information:
- CMS Emergency Preparedness Rule webpage
RSV Vaccines for Older Adults
CDC recommends a single dose of an RSV vaccine for everyone ages 75 and older and for people ages 60–74 who are at increased risk of severe RSV. Adults ages 60-74 are considered at increased risk if they have one or more of the following risk factors:
- Chronic heart or lung disease
- A weakened immune system
- Certain other medical conditions*, including diabetes with complications and severe obesity
- Live in a nursing home
*For a complete list of chronic health issues that lead to increased risk of severe RSV, see Clinical Overview of RSV.
OIG – Additional Oversight of Remote Patient Monitoring in Medicare Is Needed (OEI-02-23-00260)
OIG’s findings demonstrate the need for additional oversight to ensure that remote patient monitoring is being used and billed appropriately. The use of remote patient monitoring in Medicare increased dramatically from 2019 to 2022. About 43 percent of enrollees who received remote patient monitoring did not receive all 3 components of it, raising questions about whether the monitoring is being used as intended. OIG recommends that the Centers for Medicare & Medicaid Services take steps to provide additional oversight and safeguards to help ensure that remote patient monitoring is being used and billed appropriately.
Read the Full Report