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 1st Quarter of 2017, web sites of the above advertisers were visited by home care and hospice executives and staff 1312 times.

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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

ICD-10 Coding Conference
Texas Association for Home Care & Hospice

Featuring Lisa Selman-Holman
September 13-14
Westin Galleria
Houston

Receive up to 11 clock or contact hours.

http://tahch.org/tahchorg/education/icd10


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

Pre-Claim Revue Seminars
Presented by QIRT
Seminars and webinars will be offered in the pilot states in advance of each state's pre-claim start date.

  • Florida seminars in September (PCR roll out date:October 1, 2016)
  • Texas seminars in November (PCR roll out date: December 1, 2016
  • Michigan and Massachusetts seminars in December (PCR roll out date: January 1, 2017)

QIRT.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


Community 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


Technologies and Tactics Transforming Long-term Care Conference: Igniting Innovation and Best Practices Across the Long-term and Post-acute Care Continuum
Sponsored by TCBI and Telehealth and Medicine Today
June 30
Washington, DC
Information and registration

2017 Annual Conference and Trade Show *
Home Care Association of FloridaJuly 23-27
Renaissance Orlando at Sea World
Information and Registration

AHHC 2017 Leadership ConferenceAssociation for Home & Hospice Care of North Carolina
October 9-10
Holiday Inn Resort
Wrightsville Beach

Click here to register

Hospice Financial and Administrative Management Conference
Presented by The Health Group
November 6-7
Caribe Hilton
San Juan, Puerto Rico
Registration: conference@healthgroup.com
 

*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

2017 Regulatory Updates, Including Home Health Conditions of Participation

Free Webinar Hosted by DeVero Software and Relias Learning
Featured Speakers: Michael Tidd, Healthcare Synergy; Robert Love, DeVero
Tuesday, March 21
2:00 pm EDT / 11:00 am PDT

Register Here


A New Approach for Home Health Face-to-Face:
Updated Info, Updated Insights

Sponsored by Kinnser Software
Featuring Arlene Maxim, RN
Thursday, April 20
1:00 pm EDT

Learn:

  • What CMS requires for "adequate documentation" under Face-to-Face
  • How to handle inadequate progress notes provided by the physician/in-patient facility
  • Exactly what to include on your checklist of items for the physician's packet

Free: Register here



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



Leveraging Technology on Your Path for A 5-Star Rating

Sponsored by Brightree
Featuring Diane Link, RN, MHA, Blacktree Healthcare Consulting; Michael Puskarich, CEO, Kenosha VNA; Wendy Cofran, CIO, Natick VNA; Elaine Stephens, RN, MPH, FHHC, CEO, Walpole Area VNA

April 13
2:00 pm - 3:15 pm EDT

Learn:

  • The impact technology and process have on a 5-star rating
  • How to utilize dashboards to track and trend data that may impact outcomes
  • How to develop outcome scorecards, and how to use them during employee evaluations
  • How to utilize reports to identify educational opportunities

Free: Register here



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


Nursing Reference Center Plus Overview
Sponsored by VNAA
Date: Every Thursday through December 8
Time: 1:30 PM Eastern
Nurses use Nursing Reference Center Plus to get answers to questions, access care plans, watch video demonstrations, strengthen nursing skills, earn continuing education credits, access drug information and patient education.
Register and attend


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



Navigating Alternative Payment Models

Presented by Mark Sharp and Raymond Belles of BKD
Tuesday, March 28
2:00 p.m. EDT
Cost: $79
Registration

 


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 


Navigating Pre-Claim Review

The controversial Pre-Claim Review Demonstration has been delayed in FL and paused in IL. So what's next? We'll cover what we've learned, what you should be doing now, and what home health care agencies can expect next.

Sponsored by Forcura
Featuring: Nick Seabrook, BlackTree Healthcare Consulting; Craig Mandeville, Forcura; Kim Gaffey, MSN, RN, Gaffey Home Nursing & Hospice
Thursday, April 13
2:00 pm EDT

Registration Link


Hospice Proposed Rule FY2018

Presented by Curaport

Featuring Katie Wehri, CHPC, Healthcare Provider Solutions
Tuesday, June 6
2:00 p.m. EDT
Cost: $89
Registration


QAPI Overview

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


Understanding the Effect Functional Scoring Has on Your Agency

Presented by Curaport

Featuring Chad Whitefield, PTA, Managing Partner of Advance Rehabilitation Management Group
Monday, June 12
2:00 p.m. EDT 
Cost: $59 
Registration


The Trump Effect: How the New Administration is Impacting Homecare

Presented by Curaport

Featuring Angelo Spinola, Shareholder, Littler Mendelson PC
Thursday, June 29
11:00 a.m. EDT 
Cost: $99 
Registration



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

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