Volume 5, Number 42 June  29, 2016



Dear Healthcare at Home Colleague,

Though we have no targeted news article about it in this week's issue, we continue to watch CMS's attempts to explain the regulatory details underlying its 5-state pilot of a pre-claim approval system. Couched as a cash-flow enhancing measure for non-fraudulent providers, the rule looked less and less like that as more clarifications appeared this week.

First, additions to the official FAQ page confirmed that physician-signed plans of care and Face-to-Face documents will have to be submitted with your application for pre-claim approval. Agency workers from coast to coast have told us over the years how difficult it is to get physicians signatures by the END of a 60-day episode. The single sentence asserting this requirement makes clear that CMS has no understanding how heavy of a burden this will impose. If you listen closely, you can almost hear the implied "no big deal" at the end of this statement:

"Pre-claim review does not create new documentation requirements. Home Health Agencies will submit the same information they currently submit for payment, but will do so earlier in the process."

The other clarification that was far less comforting than intended is the confidence that MACs will have no trouble processing hundreds of thousands of additional pages per day. 

[These are] the same contractors that currently process claims and conduct medical review on home health services. Clinical staff are assigned to medical review and trained to ensure consistency. In addition, we will employ private sector standards in our pre-claim review program, such as making every effort to respond to pre-claim review requests within 10 business days of receipt of an initial pre-claim review request, providing responses that are specific about missing information, and giving providers an opportunity to resubmit the pre-claim review request an unlimited number of times for re-review. During re-submission, the MAC will make every effort to issue a decision within 20 business days.

"Every effort" is somewhat less confidence-inspiring than "guarantee," especially when the historical record of the rate of payment denials overturned by the ALJ for improper interpretation of the rules by these same clinical staff is taken into consideration. Do the math yourself:

  • X days from start-of-care until all physician signatures are secured, PLUS
  • 10 days to receive pre-claim denial #1, PLUS
  • X days to gather missing or update inaccurate documents and re-submit, PLUS
  • 20 days to receive pre-claim denial #2, PLUS
  • X days to gather missing or update inaccurate documents and re-re-submit, PLUS
  • 20 days to receive pre-claim approval.
  • Add another two weeks to this is you submit via US Mail. Your MAC will always reply using the same document delivery system you use.

Have we reached the deadline after discharge to submit a final claim yet? If not, we are very close. Consequently, providers in Illinois, Florida, Texas, Michigan and Massachusetts, you have two goals. 1) Do not submit pre-claim requests that have a chance to be denied. 2) Do not submit via US Mail. 

We will keep an eye on this rule. Early guinea pigs in Illinois are urged to share their first experiences with us in August. In the meantime, there is other news this week...

Two of our regular sponsors have successes to announce:
Procura/ContinuLink/Igea reported record revenue for their recently closed fiscal 2016. And Consolo hospice software is expanding its headquarters, hiring dozens of new staff, and releasing software features we have not seen in other hospice software.

We also feature two guess essayists this week, each with a timely topic. Attorney and agency owner Jeffrey Grossman opines about the benefits of paying living wages, overtime, and travel time to non-medical caregivers. And home care veteran Merrily Evdokimoff, RN,PhD, teaches us about the advantages of using "Health Navigators," a new but rapidly growing job description.

Have a terrific Independence Day weekend. Keep making a difference!

 

Editor signature
Tim Rowan



Fueled by $12M Investment, Consolo Services Group Aims to Transform Hospice Software Market
In a crowded field of hospice EMR providers, Consolo has its sites set on the front row with mileage management, business intelligence, and data analytics.

Agency Owner Finds Silver Lining in SCOTUS Support of Wage Rules
Guest author Jeffrey Grossman, Esq., considers the positive impacts of new wage protections on agency bottom lines.

IRS Notice 2016-40 Extends WOTC Transition Relief for 3 Additional Months
WOTC Tax Credits are typically worth $2,400 to $9,600 per employee. For-profit organizations should apply by September 28 to receive a credit for all employees hired since 1/1/15.

Use of Health Navigators for Improved Patient Activation in Home Health Care
Merrily Evdokimoff, RN, PhD, teaches Community Health Nursing at the University of Massachusetts-Boston. In this guest article, she references several examples of the value of lay medical navigators in healthcare systems. She suggests it is time healthcare at home providers give the movement a serious look.

Procura Releases FY16 Results, Shows Record Growth, 100+ New Customers
Procura's fiscal year ended March 31 reporting record revenue and introducing four new key executives.

 
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During the 3rd Quarter of 2018, web sites of the above advertisers were visited by home care and hospice executives and staff 1726 times.

To inquire about placing your message here, contact:

Kristin@rowanresources.com

Last Week's Most-Read Stories:
Vendors and Consultants Concerned About Pre-Claim Review Rule
The more we get to know CMS's pre-claim review pilot, the more it becomes apparent that it will have some good consequences among all the disastrous ones.
 
CMS Tries to Justify Home Health Prior Authorization Rule
In its quest to quell Medicare fraud, CMS has imposed a new burden on honest and dishonest agencies alike in five states. This week, spokespersons tried to explain the new Pre-Approval of Claims process as a benefit to providers.

As of this date, approximately 22,077,000 Baby Boomers have become Medicare eligible.



Notable Upcoming Conferences Free Webinars

Public Policy Leadership Conference
Visiting Nurse Associations of America

Wednesday, September 14 at 8:00 AM through Thursday, September 15 at 3:00 PM
Washington Court Hotel
Washington, DC

More information and registration

 


By the Numbers: ICD-10 Coding Conference
Texas Association for Home Care & Hospice
September 13-14
Westin Galleria Hotel
Houston


Information and registration



By the Numbers: ICD-10 Coding Conference

Texas Association for Home Care & Hospice
September 13-14
Westin Galleria Hotel
Houston

Information and registration


HURRICANE Home Care Marketing Boot Camp 2.0 *
October 5-7
Embassy Suites Philadelphia Airport
http://homecaremarketing.net/hurricanebootcamp/

Home Care Sales and Marketing Society *
6th Annual Conference

Learn tactics and techniques for gaining more patients and clients. This year, two breakout tracks: "Field Sales Tactics" and "Internal Operational Excellence: Intake, Admissions and Inquiry."

October 6-7
Bally's Hotel and Casino
Las Vegas
Click here for more information


Annual Meeting *
National Association for Home Care and Hospice

October 23-25
Gaylord Palms Resort and Convention Center
Orlando

Information and Registration


Pre-Claim Revue Implementation
Palmetto GBA and CGS Tours Texas in Partnership with TAHC&H

Multiple Locations:
October 11 – McAllen
October 13 – San Antonio
November 16 – Houston
November 17 – Dallas
Details for each conference


The Journey Forward
South Carolina Home Care & Hospice Association Annual Conference
December 5-6
Hyatt Place + Hyatt House | Historic District
Charleston
www.schchaconferences.com

The 6th Annual Medicare Compliance Cruise *

Presented by Pearson & Bernard, PSC

January 15-22
Departs from Ft. Lauderdale
Information and registration


2017 Northeast Home Health Leadership Summit

Sponsoring Associations:

  • Connecticut Association for Healthcare at Home
  • Home Care and Hospice Alliance of Maine
  • Home Care Alliance of Massachusetts
  • Home Care Association of New Hampshire
  • Home Care and Hospice Association of New Jersey
  • Home Care Association of New York State
  • New York State Association of Health Care Providers
  • Rhode Island Partnership for Home Care
  • VNAs of Vermont

January 17-19, 2017
Colonnade Hotel
Boston

Information and Registration


OASIS-C2: The Next Steps

Texas Association for Home Care & Hospice
Presented by Lisa Selman-Holman
January 19, 2017
Westin Riverwalk Hotel

San Antonio 
Details and registration


Homecare 100 *February 4-7
Ritz-Carlton
Amelia Island, FL
Registration is full. To be added to the waiting list, contact Miriam Adams at madams@lincolnhc.com

National Leadership Conference *
Sponsored by:
Visiting Nurse Associations of America

Alliance for Home Health Quality and Innovation

April 19-21

Hilton San Diego Bayfront
https://www.homebasedcareevents.com/

Omaha System International ConferenceA Key to Practice, Documentation and Information Management
April 20-22, 2017
Eagan, MN
Bi-annual conference offers opportunities to gain knowledge about using electronic health records across diverse settings, exchanging health information, and enabling data sharing among practice, education, and research. For additional information about the conference, the call for poster abstracts and award nominations, and to register, visit www.omahasystem.org/conferences.html.
Email abstracts to lchoromanski@gillettechildrens.com

ATA Annual Meeting

American Telemedicine Association
April 23-25
Orange County Convention Center
Orlando

http://www.ata2017.org


Pediatric Home Care Conference

Texas Association for Home Care & Hospice
May 9
Omni Austin Hotel Southpark

Details and registration


New England Home Care & Hospice Conference & Trade ShowMay 16-18
Radisson Hotel
Manchester, NH
Brochure and Registration

Annual Conference *Home Care Association of Colorado
May 17-19
Keystone Resort & Conference Center
Keystone, CO
http://www.homecareofcolorado.org


Home Health Emergency Preparedness CoP Requirements:
Getting Your Agency Ready

Featuring Mary St. Pierre, RN, BSN, MGA
Free, sponsored by HEALTHCAREfirstSeptember 13

1:00 pm Central Time
Omni Austin Hotel Southpark

Details and registration

http://www.healthcarefirst.com/webinars/

  • Overview of the emergency preparedness requirement
  • What surveyors will be looking for
  • Steps home health agencies should take to prepare

2018 Annual Conference

AHHC of North Carolina

May 7-9
Sheraton Imperial Hotel & Convention Center

Register


West Coast Payer and Provider Summit to Address Social Determinants of Health for Complex PopulationsA World Health Care Congress Executive Series Event

June 4-5

Doubletree Resort Paradise Valley
Scottsdale, AZ


Download agenda

Post Acute 360: Strategy and Solutions Conference

Presented by: Lincoln Healthcare Leadership

June 25-27
Gaylord National Resort
National Harbor, MD
Information and Registration


NAHC Financial Managers Meeting

July 15-17
Austin, TX
Information and Registration


Leading in a Changing World

Texas Association for Home Care & Hospice 49th Annual Meeting
August 8-9
Moody Gardens Hotel & Spa
Embassy Suites Frisco Hotel & Convention Center
Frisco

Information and registration


Home Care Cruise

Sponsored by: HealthCare Synergy
Featuring: Melinda Gaboury, Michael Tidd, Paula Pettit
Dates: August 24-27
Location: Carnival Inspiration, Los Angeles to Ensenada, Mexico

Information and Registration

(Early Bird Pricing Ends May 15)


Medicare and Managed Care Reimbursement Necessities

Presented by HealthCare Synergy, Inc. and Illinois Homecare & Hospice Council

Featuring: Melinda Gaboury, COS-C
Date: Wednesday, September 5
Time: 8:30 am CDT
Location: Northern Illinois University

This is an In-person Workshop and Live Webinar

Information and Registration

(HealthCare Synergy clients, call for a special discount: 714-229-8700; ext 118 for Rangsey Ouk or ext. 137 for Edleen English.)

To maximize your reimbursement, you need to be well informed. Melinda Gaboury of Healthcare Provider Solutions, and a trusted consultant for HealthCare Synergy, will help you stay on top of constantly changing regulatory requirements so you can get paid.


Hospice Financial and Administrative Management Academy

Presented by: The Health Group, LLC

Date: September 17-18
Location: Mirage Las Vegas

Information and registration


2018 National Leadership Conference *

Home Care Association of America

Date:
September 22-25
Location: Marriott Wardman Park Hotel
Washington DC

 

Information for Providers and Exhibitors


NAHC 2018 Annual Meeting*National Association of Home Care and Hospice
October 7-9
Gaylord Texan
Grapevine, TX

Information and registration


TRANSFORMATIONS *
New York Association of Health Care Providers
Annual Management Conference and Exhibition


October 23-24
Uniondale, NY
Information and registration


*HCTR will see you there.

Your state or national association meeting not listed? Send the details to Conferences@RowanResources.com using this format:

Conference Title
Sponsoring Association
Date(s)
Hotel or Conference Center, City, State
URL

Final Modifications to the Quality of Patient Care Star Rating Algorithm Call

Presented by HealthcarefirstHosted by CMS
Wednesday, October 3
2:00 pm EDT / 11:00 am PDT
Free

Register Here

During this call, learn about planned modifications to the Home Health Quality of Patient Care star ratings, including:

  • Removal of the Drug Education on All Medications Provided to Patient/Caregiver during All Episodes of Care measure
  • Addition of the Improvement in Management of Oral Medications measure.

CMS presents the rationale, timing, and impact of this change. A question and answer session follows the presentation.



 

Wound Care Basics: Acute and Chronic Wound Healing
Presented by Curaport
Featuring:
Myra Varnado, BS, RN, CWOCN, Director of Clinical Services, Corstrata
Date: Thursday, October 9
Time: 2:00 pm EDT

Fee: $59
Register
*This education session is approved for one (1) contact hour of Continuing Education for Nursing
Providing the best level of Wound Care for your patients is an expensive and daunting task.  Or is it?  To be an expert at Wound Care, you first must master the basics.  This education session will get your clinicians on the right path to improving outcomes for your Wound population.  Part 1 of a 4-part Series.


How to be the TOP DOG Sales Rep
Sponsored by PlaymakerCRM
Featuring Cheryl Peltekis, RN
December 14
2:00 EST
Register here


Grow Your Census with Online Marketing Tools

Sponsored by Shoshana Technologies

October 20
http://rosemarksystem.com



Public Policy Leadership Series

Presented by: ElevatingHOME

Featuring:

• Joy Cameron, Vice President, Policy and Innovation, ElevatingHOME and VNAA
• Bill Dombi, President, National Association for Home Care & Hospice
• Sarah Myers, Partnership for Quality Home Healthcare

Schedule: Wednesdays, October 3 - November 7
Session 1: October 3
Time: 1:00 pm EDT
Fee: Free to ElevatingHome, VNAA, and Alliance for Home Health Quality Improvement members

Click here for complete schedule and registration




Navigating the Final Rule for Medicare PPS for CY 2017
Sponsored by PPS Plus
Tuesday, November 15, 1:00 - 2:30 pm CST
Featuring Dave Macke, CHFP, FHFMA
Director of Reimbursement Services, VonLehman & Company
FREE

Register here


P2P Forum: Strategies to Improve Your Referral, Intake, and Order Processes

Presented by HealthcareFirst
Hosted by CMS

Date: September 13
Time: 2:00 pm EDT
Fee: None

Information and registration

If your home health or hospice agency spends a large amount of time processing documentation associated with referrals, intake, and orders, delaying turnaround times and billing, you will not want to miss this Forum. Kim Gaffey, MSN, RN, owner of Gaffey Home Nursing & Hospice, will share how her agency has significantly improved accuracy, compliance, and turnaround time while reducing time spent managing documentation with HEALTHCAREfirst and Forcura. They are now receiving orders within 24-48 hours and are billing RAPs within 7 days of the start of care, improving their cash flow and profit margins too! Join us to learn how you can experience results like these in this 30-minute open forum. 



Why your claims are being denied:  Performing a self-assessment of your ZPIC, Pre-Claims, and VBP liabilities

Featuring Michael McGowan, CEO, OperaCare
Tuesday, January 17
2:00 p.m. EST
Cost:  $79
Register


2017 What You Need to Know about Electronic Visit Verification

EVV offers many benefits to agencies and care providers, and choosing the right solution can lead to improved operating efficiency, caregiver communication, quality of care, and client satisfaction.

Wednesday, March 15
11:00 am MST - 12:15 pm MST

Register Here



PDGM is on the Horizon - What Now?

Presented by Netsmart

Featuring: Chris Attaya, President, Rapid Recovery Center; AJ Peterson,Netsmart VP of Interoperability

Date: Thursday, October 25
Time: 2:00 pm EDT
Fee: None

Register
To thrive in the regulatory climate today, it’s important to stay ahead of the changes and adjust your business model to face the challenges. That is why we invited Strategic Healthcare Programs (SHP) to share the latest updates from CMS and to review the components of the proposed Patient-Driven Groupings Model (PDGM) program.  
Using data from the SHP national database, Chris Attaya, vice president of product strategy, and Zeb Clayton, vice president of client services, will identify the expected winners and losers of the new model. They will share insights around the operational and clinical changes you need to consider to remain a vital organization. Teresa Craig, director of client strategy for Netsmart, will join the discussion to outline what you should expect from your EHR partner as you prepare for the new PDGM requirements.
Key Takeaways:
  • The latest updates from CMS and the components of the proposed PDGM model
  • Insights to help your agency prepare for a PDGM-like model
  • How to work with your EHR partner to prepare for new requirements


Under Pressure — OASIS Service Utilization Review

Presented by Michael McGowan of OperaCare
Thursday, April 6
12:00 p.m. EDT
Cost: $49
Registration



What You Need To Know About Electronic Visit Verification
Presented by Darby Anderson, CDO, Addus HomeCare Corporation
Sponsored by CellTrak
Wednesday, April 12
1:00 p.m. EDT
Cost:  Complimentary
Registration link
 


Understanding the Effect Functional Scoring Has on Your Agency
Presented by Chad Whitefield, PTA, Managing Partner of Advance Rehabilitation Management Group
Thursday, April 13
2:00 p.m. EST
Cost:  $99
Registration link 


Increase Referrals, not Overhead- Streamlining the Intake Experience

A streamlined, efficient intake process creates a better patient experience and improves referral relationships. During this webinar, industry experts will share their quick tips and best practices for improving your intake process and managing your organization's revenue cycle.

Sponsored by Forcura
Featuring: Craig Mandeville, Founder & CEO of Forcura Jessica Stover, Senior Manager of Blacktree Healthcare Consulting
Tuesday, Oct 3
2:00 pm EDT

Registration


QAPI Overview

Presented by Diane Link, BlackTree Healthcare Consulting
Tuesday, May 23rd
2:00 p.m. EST
Cost:  $99
Registration


OASIS-D: Ensuring Consistency & Accuracy

Presented by Curaport
Featuring:
Melissa Abbott, RN, MSN, MHA, of 5 Star Consultants

Date: Thursday, October 18
Time: 2:00 p.m. EDT

Fee: $99 (per attendee)

Information & Registration

* This education session is approved for one (1) contact hour of Continuing Education for Nursing.

OASIS! Possibly the most spoken word, or acronym, in the Home Health industry. And just when you get to grips with the current version, the next set of changes arrive before you know it, this time in the form of OASIS-D. In this webinar, you will gain an understanding of the significant changes D brings to OASIS and how to ensure consistencies and accuracy within your agency.

 

*Curaport, LLC is an approved provider of Continuing Education by the California Board of Registered Nursing. All states accept this certification for their licensing requirements. No refund shall be given, except for any change in date or time of the webinar. In such case, a full refund shall be given to the registrant upon request.



Building a Successful, Data-Driven Quality Program

Presented by Brightree

Featuring: Rhonda Dornbos, RN, BSN, Chief Clinical Information Officer, DB HealthTech Consulting
Date: Wednesday, September 26
Time: 1:00 pm CDT

Free Registration

The home care and hospice industry is increasingly competitive. The shift from “volume” to “value” means that agencies must increasingly focus on quality outcomes and prove their “worth” to customers and referral sources alike.  Agencies must have a robust quality program in place that identifies, tracks, and trends key metrics against agency goals.  Successful agencies not only have visibility into their current performance, but they continually modify and develop new strategies for improvement, while engaging their clinicians.



Using a Sales & Marketing Dashboard to Get Ahead of Your Competition

Presented by Curaport

Featuring: Melanie Stover, OT, MBA, Homecare Sales

Date: Wednesday, September 5
Time: 2:00 p.m. EDT
Fee: $59 (per attendee)

Information and registration

Webinar Overview
Driving patient admissions and revenue is the top priority for your sales team. Creating a system that quickly monitors production is key to keeping your agency on track for sustainable growth.

This webinar will provide your agency with 3 ways to use your dashboard to get ahead (and stay ahead!) of your competition.



Introduction to the CMS Electronic Medical Documentation Interoperability (EMDI) Program

Presented by: ElevatingHome
Featuring:

  • Pallavi Talekar, Project Manager, Scope Infotech, Inc.
  • Ray Wilkerson, Sr. Business Analyst, Scope Infotech, Inc.
  • Nandini Ganguly, Business Analyst, Scope Infotech, Inc.
  • Briana Barnes, Project Coordinator, Scope Infotech, Inc.
Date: Wednesday, August 8
Time: 1:00 p.m. EDT

Registration

 

Participants will gain understanding of the CMS-driven Electronic Medical Documentation Interoperability program, focused on reducing provider burden by engaging health care providers and stakeholders in pilots that establish secure communication to share medical documentation by aligning with nationally recognized interoperable standards. This event is designed for providers and vendors who are willing to enhance their workflows and communication to achieve efficiency by reducing time and cost.

In this session participants will learn about interoperability and shift in the health care IT landscape, EMDI pilot program details, EMDI pilot program benefits, and how to partner with the EMDI to achieve interoperability.



The Penalty Box Compliance Series Part 8: The IMPACT Act

Presented by Curaport
Featuring Kristi Bajer, RN, MSN

Wednesday, May 23
1:00 p.m. EDT
$39

Information and registration

This education session is approved for one (1) contact hour of Continuing Education.



Webinar hosts, send your announcements to: Conferences@RowanResources.com

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