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:: NAHC Report
NAHC Report: Issue# 2180, 4/23/2013
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CMS J11 MAC Suppresses RAP Payments
Portion of Hospice PEPPERs to be Reissued
For Your Information: NAHC – DecisionHealth Launch National Survey of Home Health Industry Readiness
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CMS J11 MAC Suppresses RAP Payments

Palmetto GBA, the largest home health and hospice Medicare Administrative Contractor (MAC) has taken steps to suppress payments to home health agencies identified as having a “high number” of auto-cancelled Requests for Anticipated Payment (RAP). The National Association for Home Care & Hospice (NAHC) learned that RAP payments are being suppressed for 298 home health agencies because they failed to submit final claims as required, resulting in RAPS being auto-cancelled between January and April 2013. The targeted agencies had 100 or more RAPS auto-cancelled. Several agencies had more than 1,000 RAP cancellations and at least one had over 4,000.

For these home health agencies, “RAPs will be set to pay at zero percent. The payment suppression will continue until a Corrective Action Plan is submitted and the provider can demonstrate improvement in timely billing of final claims.”

According to the Palmetto GBA bulletin informing home health agencies of RAP payment suppression, “Providers are given the greater of 120 days after the start of the episode or 60 days after the paid date of the RAP to submit the final claim. If the final claim is not submitted within the specified time, the RAP will auto-cancel and the provider must resubmit the RAP before submitting the final claim.”

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NAHC – DecisionHealth Launch National Survey of Home Health Industry Readiness

With the ICD-10 effective date a mere 18 months out, CMS has urged that provider planning and preparation should be well underway. To assess industry readiness, and therefore appropriate aid and lobby for your specific concerns, DecisionHealth and the National Association of Home Care & Hospice today launch the National Home Health ICD-10 Readiness Study.

You are urged to participate in what we aim to be the largest study of ICD-10 preparedness specifically targeting home care provider types.

This study has two phases: The first, to in identify current readiness, reporting baseline results at DecisionHealth’s ICD-10 Impact Conference in June. The second, to benchmark progress on ICD-10 transitioning with a follow-up study, will be conducted this fall.

A detailed report of results will be shared for free with all who participate in the survey.

Tell us where you stand on the road to ICD-10, and we’ll make sure the industry as a whole knows what to expect next October, based on where everyone is now.

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Portion of Hospice PEPPERs to be Reissued

TMF Health Quality Institute, the Centers for Medicare & Medicaid Services (CMS) contractor for the hospice Program for Evaluating Payment Patterns Electronic Report (PEPPER) has alerted the National Association for Home Care & Hospice (NAHC) that they have identified a problem in the recently-released Hospice PEPPER (see NAHC Report, March 7, 2013). As a result, about half of the PEPPER reports recently sent to hospices must be revised and reissued.

The target area definition for the “Live Discharges” target area was revised for episodes of service that ended July 1, 2012 and later in order to be compliant with CMS Change Request 7677, which introduced additional codes for hospices to use to indicate the reason a beneficiary was discharged alive. The programming code for calculating these statistics was correct. However, for episodes ending prior to July 1, 2012, TMF found an error in the programming code.

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