Volume 5, Number 42 September  21, 2016



Dear Healthcare at Home Colleague,

I spent this week digging into the CMS decision to postpone its Pre-Claim Review pilot in Texas, Florida, Michigan, and Massachusetts. It comes down to their admission that it is not working in Illinois but the jury is out regarding why it is not working. CMS says Illinois providers are at fault and need more education. Illinois providers, and their state association, are convinced that it is Palmetto GBA reviewers who do not understand their own rules. There is also much confusion as to why the experiment, if CMS believes it has failed, was not stopped in Illinois rather than merely being postponed for future pilot states. 

I interviewed several Illinois HHA owners and an official with the Illinois Homecare and Hospice Council this week and I sat in on the IHHC conference call with NAHC's Bill Dombi. Last June, I also participated in the CMS Open Door Forum in which staffers outlined the Center's expectations for the experiment, expectations that largely failed to materialize. 

To the best of my ability, I have analyzed the Illinois experiences as reported by HHAs in Chicago and downstate. The three articles in this week's issue are the result of that analysis. I hope you find them useful. Most of all, I hope these articles are not read solely in Illinois. Even though early results have proven that Pre-Claim Review, in its current form, fails in its mission to separate fraudulent providers from honest ones, CMS continues to give every indication that they intend to go forward with the 5-year pilot and eventually expand it nationwide. Every Medicare provider reading this page needs to be prepared, not just my readers in the pilot states. 

I have done my best to help you prepare but there are of course many other sources. You need them all. Consider just one thing you will learn in my articles. Illinois is experiencing an 80% pre-claim "non-affirmation" rate. What will it mean to beneficiaries if that happens in 50 states? If there is a bottom line, it is this: every Medicare agency in the five pilot states and beyond needs to get on the phone with their Representatives and Senators and teach each one's staffer assigned to healthcare issues the truth about how badly this experiment is going. They are getting a different message from CMS, as you will see in my lead article.

Just before pressing 'send' on this week's issue, I saw that CMS has canceled its Open Door Forum that had been set for October 5. Their reason is that is conflicts with a National Provider Call on Emergency Preparedness Requirements. We will keep watch for any announcement of another ODF dedicated to the Pre-Claim Review experiment.

We will get back to our normal variety of topics next week but for now this is the story that impacts most of you so we have dedicated the entire issue to it.

Have as great of a week as you can. Keep making a difference!

Editor signature
Tim Rowan



CMS Postpones Pre-Claim
To many, CMS's decision to postpone implementation of the Pre-Claim Review experiment in Texas, Florida, Michigan, and Massachusetts does not come as a surprise. Poorly trained reviewers make so many mistakes, it may be wise to turn the program off in Illinois as well, where it has already begun but is not working.

Illinois Home Health Providers Frustrated, Angry, But Not Powerless
Almost everything that can go wrong has gone wrong in the first state burdened with poorly planned Pre-Claim Review experiment.

Home Health Providers Bear Some Responsibility Too
In marriage and in Medicare, there are always two valid sides to every argument. Just because most of the blame for the Illinois fiasco can be attributed to PGBA does not mean that HHAs are blameless. Those who intend to be in business next year must set the bar higher for employees who create, review, and submit clinical documentation.

Texas Association Urges Members to Continue PCR Training
In spite of the announced PCR delay, the Texas Association for Home Care and Hospice is warning its members to remain vigilant and continue preparing, saying, "PCR is still coming."

 
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Notable Upcoming Conferences Free Webinars

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
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HURRICANE Home Care Marketing Boot Camp 2.0 *
October 5-7
Embassy Suites Philadelphia Airport
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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)

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The 6th Annual Medicare Compliance Cruise *

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January 15-22
Departs from Ft. Lauderdale
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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
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National Leadership Conference *
Sponsored by:
Visiting Nurse Associations of America

Alliance for Home Health Quality and Innovation

April 19-21

Hilton San Diego Bayfront
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Omaha System International ConferenceA Key to Practice, Documentation and Information Management
April 20-22, 2017
Eagan, MN
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ATA Annual Meeting

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

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Community Care Conference

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

Details and registration


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
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Annual Conference *Home Care Association of Colorado
May 17-19
Keystone Resort & Conference Center
Keystone, CO
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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
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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

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A New Approach for Home Health Face-to-Face:
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Sponsored by Kinnser Software
Featuring Arlene Maxim, RN
Thursday, April 20
1:00 pm EDT

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How to be the TOP DOG Sales Rep
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December 14
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Grow Your Census with Online Marketing Tools

Sponsored by Shoshana Technologies

October 20
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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

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Navigating the Final Rule for Medicare PPS for CY 2017
Sponsored by PPS Plus
Tuesday, November 15, 1:00 - 2:30 pm CST
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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
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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
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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
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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
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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

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Hospice Proposed Rule FY2018

Presented by Curaport

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