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National Association for Home Care & Hospice
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In the various roles he has undertaken through the years, Val J. Halamandaris has been a singular driving force behind the policy and program initiatives resulting in the recognition of home health care as a viable alternative to institutionalization. His dedication to consumer advocacy, which enhances the quality of life and dignity of those receiving home health care, merits VNA HealthCare Group’s highest recognition and deepest respect. 

VNA HealthCare Group

I have the highest respect for them, especially for the nurses, aides and therapists, who devote their lives to caring for people with disabilities, the infirm and dying Americans.  There are few more noble professions.

President Barack Obama

Home health care agencies do such a wonderful job in this country helping people to be able to remain at home and allowing them to receive services

U.S. Senator Debbie Stabenow (D-MI) Chair, Democratic Steering and Outreach Committee

Home care is a combination of compassion and efficiency.  It is less expensive than institutional care...but at the same time it is a more caring, human, intimate experience, and therefore it has a greater human’s a big mistake not to try to maximize it and find ways to give people the home care option over either nursing homes, hospitals or other institutions

Former Speaker of the U.S. House of Representatives Newt Gingrich (R-GA)

Medicaid covers long-term care, but only for low-income families.  And Medicare only pays for care that is connected to a hospital discharge....our health care system must cover these vital services...[and] we should promote home-based care, which most people prefer, instead of the institutional care that we emphasize now.

Former U.S. Senator Majority Leader Tom Daschle (D-CD)

We need incentives to...keep people in home health care settings...It’s dramatically less expensive than long term care.

U.S. Senator John McCain (R-AZ)


Home care is clearly the wave of the future. It’s clearly where patients want to be cared for. I come from an ethnic family and when a member of our family is severely ill, we would never consider taking them to get institutional care. That’s true of many families for both cultural and financial reasons. If patients have a choice of where they want to be cared for, where it’s done the right way, they choose home.

Donna Shalala, former Secretary of Health and Human Services

A couple of years ago, I spent a little bit of time with the National Association for Home Care & Hospice and its president, Val J. Halamandaris, and I was just blown away. What impressed me so much was that they talked about what they do as opposed to just the strategies of how to deal with Washington or Sacramento or Albany or whatever the case may be. Val is a fanatic about care, and it comes through in every way known to mankind. It comes through in the speakers he invites to their events; it comes through in all the stuff he shares.

Tom Peters, author of In Search of Excellence

Val’s home care organization brings thousands of caregivers together into a dynamic organization that provides them with valuable resources and tools to be even better in their important work. He helps them build self-esteem, which leads to self-motivation.

Mike Vance, former Dean of Disney and author of Think Out of the Box

Val is one of the greatest advocates for seniors in America. He goes beyond the call of duty every time.

Arthur S. Flemming, former Secretary of Health, Education, and Welfare

Val has brought the problems, the challenges, and the opportunities out in the open for everyone to look at. He is a visionary pointing the direction for us. 

Margaret (Peg) Cushman, Professor of Nursing and former President of the Visiting Nurses Association

Although Val has chosen to stay in the background, he deserves much of the credit for what was accomplished both at the U.S. Senate Special Committee on Aging, where he was closely associated with me and at the House Select Committee on Aging, where he was Congressman Claude Pepper’s senior counsel and closest advisor. He put together more hearings on the subject of aging, wrote more reports, drafted more bills, and had more influence on the direction of events than anyone before him or since.

Frank E. Moss, former U.S. Senator

Val’s most important contribution is pulling together all elements of home health care and being able to organize and energize the people involved in the industry.

Frank E. Moss, former U.S. Senator

Anyone working on health care issues in Congress knows the name Val J. Halamandaris.

Kathleen Gardner Cravedi, former Staff Director of the House Select Committee on Aging

Without your untiring support and active participation, the voices of people advocating meaningful and compassionate health care reform may not have been heard by national leaders.

Michael Sullivan, Former Executive Director, Indiana Association for Home Care

All of us have been members of many organizations and NAHC is simply the best there is. NAHC aspires to excellence in every respect; its staff has been repeatedly honored as the best in Washington; the organization lives by the highest values and has demonstrated a passionate interest in the well-being of patients and providers.

Elaine Stephens, Director of Home Care of Steward Home Care/Steward Health Systems and former NAHC C

Home care increasingly is one of the basic building blocks in the developing system of long-term care.  On both economic and recuperative bases, home health care will continue to grow as an essential service for individuals, for families and for the community as a whole.

Former U.S. Senator Olympia Snowe (R-ME)

NCOA is excited to be part of this great event and honored to have such influential award winners in the field of aging.

National Council of Aging

Health care at home…is something we need more of, not less of.  Let us make a commitment to preventive and long-term care.  Let us encourage home care as an alternative to nursing homes and give folks a little help to have their parents there.

Former President Bill Clinton

NAHC Offers Tips for ICD-10 Preparations

June 15, 2015 09:39 AM

The implementation date for the ICD-10 is fast approaching.  All providers, health plans, and clearinghouses must comply with ICD-10 regulations as ‘covered entities’ under the Health Insurance Portability and Accountability Act (HIPAA).  The National Association for Home Care & Hospice (NAHC) has heard reports of varying levels of preparedness among home health and hospice providers.  Some providers have been preparing for some time, while others have made little effort towards preparations.  

NAHC urges agencies that have not begun preparation or have invested little in terms of preparations to begin NOW; Oct 1 will be upon us sooner than you think.  Although late in the game, there is still time for meaningful progress. 

The first step is to assign a team responsible for ICD-10 preparations.  This could be one or several individuals, depending on your agency size, who is/are aware of the gaps and can coordinate efforts to aid in improving preparedness.  Next, the agencies need to conduct a gap analysis.  A gap analysis allows the agency to understand where they are and what they need to do to reach their goal.

During the gap analysis examine the processes for all departments.  For example, is the billing department up to the task and will your software vendors be ready in time for the conversion?   Have any of your staff been trained and which staff members?  Keep in mind: just about all staff members have a role, not just the coders.  The ICD-10 code selection will be dependent on documentation from both the referral source and the assessing clinicians.  Supervisors and the quality performance team will need to understand ICD-10 coding to ensure the most accurate code has been selected. 

Because there will be a heavy reliance on documentation, agencies will need to work with their referral sources in obtaining as much information as possible.  Agency staff should be trained to ensure their documentation reflects accurate information related to diagnoses to allow for ICD-10 specificity.  Home health agencies  should be aware that  the Centers for Medicare & Medicaid Services (CMS) has eliminated many of the “unspecified” codes from the 2015 home health prospective payment system (HHPPS) Grouper.  CMS believes that the majority of the codes that have been eliminated contain information agencies should be able to readily identify, such as, laterality of an affected limb.

NAHC has heard that some agencies are not training any staff, even coders, because they believe that their software vendor will be able to simply apply the General Equivalence Mapping (GEM) translation.   The GEM is not intended to be used as a crosswalk between ICD -9 and ICD-10.  Many codes do not have a one to one translation between ICD-9 to ICD-10.  Therefore, agencies will need to relay on clinical documentation to code accurately.

An important part of training and preparation for ICD-10 is developing a dual coding system to match how the current ICD-9 codes will translate into ICD-10. Agencies can approach dual coding in several ways. For example, dual code all records, if feasible, or select the most common diagnoses seen by the agencies and begin listing appropriate ICD-10 codes.   Dual coding will serve to increase accuracy in coding for all providers, and for home health agencies also provide a financial analysis.  It is unclear how much change there will be in payments to home health agencies as a result of the conversion from ICD-9 to ICD-10.

Another key aspect to consider for a smooth transition is to ensure your software vendors are ready, not only for the conversion, but for testing with trading partners.  Some providers have not been able to participate in end to end testing exercises because their software vendor was not ready to participate.  In addition, most agencies will need their software vendor’s assistance   in order to dual code.  Agencies must understand where their software vendors are in terms of readiness and any contingency plans.  CMS has finally released the 2015 HHPPS Grouper  which will allow agencies and vendors to progress in their preparations.

It is necessary for agencies to engage with their payer sources and clearinghouses as part of their readiness plan for ICD-10 implementation.  Once your agency is ready to covert to ICD-10, testing with trading partners to ensure their readiness is imperative. The agency’s readiness for ICD-10 implementation is only half of the equation for a complete transition.

For agencies that need assistance with preparation, working with a consultant that specializes in home health and/or hospice operations may be the best approach.  NAHC has on it web site an ICD-10 resource page that list tools and materials contributed by home health and hospice consultants  to assist providers to prepare for the conversion.  Agencies contemplating this approach should contact a consultant as soon as possible or you may not be able receive the assistance you need in time.

In addition to consultants, many agencies have chosen to outsource their coding, which is another good option.  However, agencies will still need to determine whether the organization conducting the coding can meet the agency’s needs.  Productivity standards and accuracy in coding should be part any negotiation.  Agencies are ultimately responsible for the product(s) produced by outside contractors.  Similar to contracting with consultants, agencies will need to move soon if outsourcing is how they choose to proceed.

Regardless of the level for which providers are prepared or whether the coding will be handled internally or externally, be assured   there will be claims processing problems and potential delay in payments.  The degree of disruption remains to be seen, but all health care providers should be financially prepared for prolonged delays.  Some industry experts recommend providers have funds, either cash on hand or a line of credit, to maintain operations for three to six months.   

Although Medicare is not the only payer that will be impacted by the conversion to ICD-10, they are largest payer for most home health and hospice providers.  At this point, CMS has not provided any information specific to home health and hospice.  The majority of the information is either very general or geared towards physician practices.  NAHC has been in contact with a CMS contractor for ICD-10 implementation about their plans for a webinar specific to home health and hospice providers, but no details have been provided.

In addition, home health agencies have some unique issues with the ICD-10 conversion; both in terms of the complexity of coding that will be required for claims that span October 2015 and the potential impact on payments.  NAHC is drafting a letter to CMS officials that addresses some of the concerns with the ICD-10 implementation. The letter will be shared with members in a follow-up NAHC report article.




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