Volume 8, Number 43 — May 29, 2019
Dear Healthcare at Home Colleague,
Our lead news story this week concerns an investigative finding by the HHS Office of Inspector General that extrapolated a $55,000 overpayment into a $7.5 million repayment demand. You will want to read how the accused Illinois HHA is fighting back in court. Many agencies hit with unreasonable overpayment demands have chosen the Chapter 11 route and closed their doors. Click below on "OIG Uses Homebound Status and Skilled Care Need to Target Providers" to read the official OIG statement.
We accompany this story with one of our occasional editorial comments, believing the details needed some elaboration and interpretation. We interviewed an attorney and a former CMS employee to try to understand how reviewers' extrapolation power started to spiral out of control. In the process, we think we found the source of the problem. You'll be surprised to discover who it is. But a solution may be on the horizon. Apparently, CMS has decided it is as much of a victim of the situation as the accused HHAs are. When an agency shuts down instead of paying, CMS is left with nothing.
This is important because it could happen to any home health agency, in fact, to any Medicare provider. In our opinion piece, we think the experts we interviewed gave us a solid understanding of not only how this happens but why extrapolation became a death sentence. Click on "What Does the OIG vs EHS Story Mean?" As always, let us know what you think by writing to editor@homecaretechreport.com.
In our continuing examination of strategies to prepare for the major Medicare reimbursement changes coming in January, we invited a guest author to discuss the advantages of outsourcing coding and billing functions. Though Kristin Donar is Director of Revenue Cycle Management for HEALTHCAREfirst, she has sent us a vendor-neutral argument in favor of letting professionals take over certain tasks in order to improve accuracy and timeliness and, consequently, increase episode payment levels.
News for non-medical providers:
While the news is heavily oriented toward Medicare skilled providers this week, private duty providers will be interested in our Vendor Watch column, especially you who are searching for value to add to your services. GrandCare is a technology company that places large-screen communication systems into homes to allow designated family members and professional caregivers to remotely monitor and communicate with clients in their residences. The Wisconsin company announced the appointment of a new CEO this week, longtime friend of and occasional contributor to this publication, Laura Mitchell, who started in marketing and rose up through the ranks to take the reins.
It was good to see so many regular readers in New York, Colorado, and Pennsylvania this month. I get to stay home for a while but am looking forward to meeting more of you at the NAHC Financial Managers conference in July, the LincolnHealth Senior Living 360 gathering in August, and the HCAOA Annual Meeting in September.
Senior staff reporter Darcey Trescone and I wish you a great week and a great summer. Keep making a difference!
OIG Uses Homebound Status and Skilled Care Need to Target Providers
A Chicago-area HHA received a $7.5 million overpayment bill from the OIG. This is the OIG statement on one example case among many.
What Does the EHS vs. OIG Story Mean?
This could happen to any HHA. Understand the financial and political motivations on all sides before it happens to you.
Outsourcing Coding and Billing: Key to PDGM Success?
As PDGM will demand a higher level of accuracy and timeliness, it may make sense to outsource coding and billing to experts.
CMS News: Hospice Compare and PACE Improvements
— National Training Program Monthly Update Webinar
— May 2019 Hospice Compare refresh of quality data is now available; now includes additional information on hospice characteristics to complement existing quality and patient experience metrics.
— Final rule removes redundancy, reduces administrative burden on PACE providers.
Vendor Watch
— GrandCare Systems appoints Laura Mitchell as new CEO, expands executive team
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During the 4th Quarter of 2020, web sites of the above advertisers were visited by home care and hospice executives and staff 4319 times. To inquire about placing your message here, contact: Kristin@rowanresources.com As of this date, approximately 33,781,000 Baby Boomers have become Medicare eligible. |
Last Week's Most-Read Stories:
PDGM Vendor Perspectives and Preparations
Music as Medicine to Improve Patient Outcomes
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Webinar: Post-Acute Care Quality Reporting Programs
Presented by: CMS
Date: Thursday, November 14
Time: 2:00 - 3:00 pm EST
Fee: Free
Description: The Centers for Medicare & Medicaid Services (CMS) will be hosting a webinar for Medicare-certified hospice providers to provide an overview on Hospital Quality Reporting Program (HQRP) requirements.
During this webinar, CMS subject matter experts will provide information on the following topics:
- Hospice Item Set (HIS) reporting requirements;
- HQRP compliance cycle;
- How to achieve hospice compliance;
- CAHPs survey requirements; and
- How to switch CAHPS survey research vendors.
CMS will answer questions at the end of the webinar as time permits.
Register
WEBINAR: Key Documentation Issues for 2020 & the Future
A 90-Minute Lunch & Learn Audio Conference by Elizabeth E. Hogue, Esq. Health Care Attorney
Date: March 18
Time: 1:00 - 2:30 EDT
Encore date: March 25; On-demand recording available
Information and Registration
Documentation remains a key requirement for home care providers as the consequences for inadequate documentation become more severe.
- What can home health agencies do to avoid denials by ZPICs, RACs, etc., for lack of homebound status and reasonable and necessary care?
- What kind of documentation must home health agencies, hospices, private duty agencies and HME companies maintain regarding gifts to referral sources and payments to physicians who make referrals to them?
- How can providers avoid an increase in enforcement action in this area?
- What kinds of documentation problems are private duty agencies facing with regard to recoupments from state Medicaid Programs?
- What dangers do electronic medical records cause for all types of home health providers?
- Is it true that if it wasn't documented, it wasn't done?
Gather your staff members to emphasize effective documentation yet again. Real examples of cases involving problematic documentation will be presented. Questions and case examples are welcome, and extensive handouts will be provided for use by staff members.
Recordings Available: Pandemic Recovery - Rebuild Stronger Than Ever
Texas Association for Home Care and Hospice
Two days of keynote and breakout presentations for home health and hospice providers.
Webinar Series: Sales Training, Home Health and Hospice
Presented by: Healthcare Strategica, LLC
Featuring: Michael Ferris
1 - 8-week Hospice & Palliative Care Sales Training Course2 - 8-week Home Health Sales Training
Rowan Report subscribers: Register with this link to receive $100 discount.
We have taken our best of class industry specific sales training bootcamps and are offering them via Webinar to enable you to continue to train your sales team in today's world of limited travel and social distancing.
The Hospice and Palliative Care course will be offered live every Tuesday starting May 19 through July 7, 2020.
The Home Health course will be offered live every Tuesday starting May 21 through July 9, 2020.
Each class will have participation exercises, homework assignments, quizzes and question and answer opportunities.
Each participant will receive their own course materials and individual coaching and feedback. At the conclusion of the course each student will receive a certificate of completion, an invitation to join the exclusive Sales Mastery Group* and opportunity to join the 52-week Sales Training Excellence Course.*
* Only available to Sales Professionals that have successfully completed the 8-week Sales Training Course – additional fees may apply.
Each session will be offered on-demand and if unable to attend the live webinar, you will be able to view the recording and participate in exercises, questions, coaching and quizzes. If you start after the first webinar date, you will be provided with access to those classes missed so that you can get caught up or you may elect to attend via the recorded sessions.
FREE WEBINAR: How Technology Enhances Home Care in an Increasingly Remote World *
Sponsored by: Care Connect
Moderator: Tim Rowan
Panelists: Mike Gelman, President COO, CareConnect; Jim Rolla, SVP, VNSYNY Partners in Care; Steve Pellito, SVP, Provider Sales, Sandata
Date: November 12
Time: 1:00 pm EDT
FREE WEBINAR: Cybersecurity in Healthcare: Assess Threats & Reduce Your Risk
Presented by: Netsmart
Featuring: Randy Pargman, Binary Defense senior director of threat hunting and counterintelligence; Sharon Hicks, MBA, MSW, OPEN MINDS senior associate; and Mike Murray, Netsmart director of Plexus Technologies,
Date: December 9
Time: 1:00 EST
Healthcare organizations are often at risk of cyberattacks due to a lack of dedicated IT and reliance on traditional reactive approaches. To learn how to protect your data, register now to join Randy Pargman, as they map the risk landscape and provide guidance for safeguarding your organization.
Key takeaways:
• Cyber threats in healthcare
• Impacts of a data breach
• Best practices for securing your data
FREE WEBINAR: Can you collect Cash faster?Sponsored by: Savii
Date: Tuesday, January 12
Time: 2:00 pm EST
With small margins in home care it has prompted the question, “Can we collect cash faster?” And what would this do for an agency? One thing we know is margins are small and have become more challenging than ever to for agencies to profit. This doesn’t mean it impossible for agencies to survive; it means a focus on collecting cash faster will be ever so important.
Agency leaders will first need to develop a timeline cadence of when to address claims based on when they were submitted for payment. In addition it will be pertinent to understand their own agency metrics such as DSO (Daily Sales Outstanding) and how they compare to industry standards.
On this webinar you will walk away with how to develop a timeline and your own DSO dashboard for benchmarking. All of these topics will weave into strategic steps to take toward collecting cash flow faster.
FREE WEBINAR: The Rise of Hospital at Home: A Roundtable Discussion
Sponsored by: AlayaCare
Featuring: Dr. Bruce Leff, Hospital at Home Pioneer & Professor, John Hopkins School of Medicine; Adrian Schauer, Founder and CEO
AlayaCare; Joel Theisen, Founder and CEO, Lifesprk; Brady Murphy, VP Sales & Marketing, AlayaCareDate: Wednesday, January 27
Time: 1:00 EST
Information and RegistrationAgenda
Across the U.S., the Acute Hospital Care at Home initiative from CMS is taking off amid the pandemic with at least 80 approved participants to date. As hospital-at-home models become more popular and more beneficial to both patients and health care organizations, those that have recognized the perks of home-based care prior to the COVID-19 crisis may have the upper hand.
Join us on Wednesday, Jan 27th at 1:00 pm EST for a roundtable discussion with industry experts such as Dr. Bruce Leff, Hospital at Home Pioneer and Professor at John Hopkins School of Medicine who deserves his reputation as a founding father of this virtual hospital concept, to learn about the hospital-at-home model and its impact on the home care industry.
FREE WEBINAR: 6 New COVID-19 ICD-10 Codes to Learn Webinar
Presented by: Healthcare Synergy
Featuring: Michael Tidd, HealthCare Synergy Clinical ManagerDate: Thursday, February 4
Time: 11:00 - 11:30 PST
COVID-19 has resulted in multiple waivers along with changes to programs and treatments to patients. April 1 had an unexpected release of a new diagnosis code for the COVID-19 disease. October 1 had additional diagnosis codes for agencies to learn and use. January 1, 2021 brings six additional diagnosis codes that CMS released the week of Thanksgiving. These will not be listed in your existing diagnosis coding manuals until a new manual is released later in August.
Objectives:
Michael Tidd has over 19 years of experience in the Home Care Industry and is a frequent speaker at HealthCare Synergy Workshops and Webinars. He is a Software Developer, LVN and Certified in ICD-9/10 Coding and OASIS (COS-C, HCS-D). As the Clinical Manager for HealthCare Synergy, he directs the Outsourced Management Services, assists in directing the development of the Healthcare Assistant Web Edition, oversees the Clinical Documentation Auditing provided to clients and directs the Clinical Form Development for the Healthcare Assistant Web Edition. Michael continues to educate agencies in the ongoing regulations that CMS produces, the proper application of the Medicare Conditions of Participation and completing timely, accurate and defendable clinical documentation to survive in the current Medicare Reimbursement Model.
FREE Webinar: Practical Application of Information Blocking and Interoperability Rules for Post-Acute Care Providers
Sponsored by: Complia Health and Kno2
Date: February 18
Time: 1:00 ESTJoin healthcare technology experts Alan Swenson, VP of Interoperability at Kno2, and Melissa Turner, Director of Integration at Complia Health, on Thursday, February 18th at 1pm Eastern to learn about information blocking and what it means for your post-acute care organization today and looking ahead to the future.
Virtual Conference: Winter Leadership Summit
Presented by: National Association for Home Care and Hospice
Date: February 23, 2021
FREE WEBINAR: New, Science-Based Methodology Reduces Cost of Recruitment and Retention
Presented by: MiliMatch
Featuring: Eric Becker, CEO
Date: Thursday, February 25
Time: 3:00 pm EST; Noon PST
Information and Registration
Agenda:
Every time a home care agency hires and trains a new caregiver, it invests about $4,500, which is wasted if that new hire does not work out, often before working a first shift. MiliMatch CEO Eric Becker will explain the company's patented product/service, based on the science of Applied Cognitive Linguistics, which has been proven to help home care agencies avoid those costly bad hires.
FREE WEBINAR: The Future Home Health Patient: An Exclusive Conversation with Encompass Health’s Bud Langham
Sponsored by: Synzi
Date: February 25
Learn how Encompass Health is planning for post-pandemic patient care and evolving its use of virtual care to improve patient outcomes. During this upcoming session, Bud Langham, PT, MBA (Chief Strategy and Innovation Officer at Encompass Health - Home Health and Hospice) will discuss what the future home health patient looks like post-COVID and how Encompass Health is preparing for the shift in care delivery.
Time: 12:00 PM EST
FREE WEBINARS: Virtual Seminar Series
"Building the Bridge to Hospice" and "How to Increase Referrals"
Sponsored by: WellSky
Featuring: Cindy Campbell, Jody Holmes-Dion, Bob Parker, Melanie Stover
Dates: March 2, 16, 30; April 6
Time: 1:00 - 2:30 ESTRegister for one or both webinars
Building the bridge to hospice: Leveraging connections between home health, palliative, and hospice care
Presented by consultants Cindy Campbell and Jody Holmes-Dion of WellSky and Bob Parker of Intrepid USA
CE credit offered – approved for up to 1.25 contact hours
Tuesday, March 2 | Tuesday, March 30Turn up the volume! How to increase referrals in a value-driven market
Presented by Cindy Campbell and sales and marketing expert Melanie Stover of Home Care Sales
Tuesday, March 16 | Tuesday, April 6
Homecare 100 *
Presented by: Lincoln Healthcare Leadership
Date: June 27-30, 2021
Venue: JW Marriott Marco Island Beach Resort, FL
https://www.homecare100.com/
*The Rowan Report will see you there.
Interoperability for Service Providers through CMS’s EMDI Initiative
Presented by: ElevatingHOME and VNAA
Featuring: Pallavi Talekar, Project Manager, Scope Infotech, Inc.; Ray Wilkerson, Sr. Business Analyst, Scope Infotech, Inc.; Nandini Ganguly, Business Analyst, Scope Infotech, Inc.; Kishan Patel Business Analyst, Scope Infotech, Inc.; Briana Barnes, Project Coordinator, Scope Infotech, Inc.
Date: Tuesday, July 30
Time: 12:00 pm EDT
Fee: Free to ElevatingHome, VNAA, and Alliance for Home Health Quality Improvement members
Representatives from the EMDI Initiative team will discuss interoperability using health IT standards, including Fast Healthcare Interoperability Resources (FHIR). Participants will learn about pilot opportunities with CMS to enhance provider workflow using three critical use cases. Participants will:
Security Risk Assessment Tool Overview and User Feedback Session
Presented by: CMS
Date: Wednesday July 17
Time: 1:00 pm EDT
Fee: Free
ONC and the HHS Office for Civil Rights are holding a training session and overview of the Security Risk Assessment (SRA) Tool. The tool is designed to assist small to medium providers in conducting an internal security risk assessment. This assessment will aid providers with their security risk analysis as required by the HIPAA Security Rule and the CMS EHR Incentive program. Following the webinar, participants will have the opportunity to ask questions and provide feedback.
Register
PDGM’s Behavioral Adjustments - What You Need to Know Now
Sponsored by eSolutions
Featuring: Karri Wright, Sr. Director, Product Management at Homecare Homebase
Date: Thursday, August 29
Time: 2:00 pm CDT
Fee: FreeThe webinar covers:
- CMS assumptions and intended adjustments and their impact on:
- Upcoding
- Comorbidities
- LUPA Avoidance
- Considerations for HHAs
- Evaluating your HHA data now to assess tomorrow based on today’s reality
A QUALITY JOB: Clinical Management & Care Coordination Under PDGM
Hosted by VNAA
Sponsored by MatrixCare/Brightree
Presented by Simione Healthcare ConsultantsFeaturing: Laura Wilson, RN, BSN, Sr. Manager, Simione Healthcare Consultants
Date: Wednesday, September 11
Time: 12:00 pm EDT
Free Registration
PDGM is so much more than a billing change! Home health agencies preparing for payment reform need to look closely at clinical operations to make accommodations that will uphold quality, including care alternatives that add value to the equation. In this webinar, we’ll share insights based on the findings of gap analyses to help your organization make a successful transition under the new requirements. Recommended Attendees: Clinical Managers, Intake Staff, Coders / QA, Finance & Billing personnel Hosted by VNAA, sponsored by MatrixCare/Brightree, presented by Simione Healthcare Consultants
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