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:: NAHC Report
NAHC Report: Issue# 2219, 6/18/2013
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CMMI Issues Second Round of Health Care Innovation Awards
CMS is Requiring HIPPS Codes on Medicare Advantage Claims
For Your Information: Webinar: Diagnosis Coding for Hospices Deciphered
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CMMI Issues Second Round of Health Care Innovation Awards

On May 15, the Center for Medicare & Medicaid Innovation (CMMI) at the Centers for Medicare & Medicaid Services (CMS) announced that it will be awarding up to $900 million in new funding for a second round of Health Care Innovation Awards. These awards will be made to applicants who propose new payment and service delivery models that have high likelihood of improving care and reducing costs for Medicare, Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries, with a strong focus on Medicaid and CHIP populations.

The second round of awards will build on an earlier round of funding awarded in 2012. The first round of Innovation Awards supports 107 models, ranging from $1 million to $26.5 million over a three year period. This round included a wide range of models, including models that enhance primary care, coordinate care across multiple settings, deploy new types of health care workers, help patients and providers make better decisions, and test new service delivery technologies.

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Webinar: Diagnosis Coding for Hospices Deciphered

The Centers for Medicare & Medicaid Services (CMS) has indicated multiple times that hospices should follow ICD-9-CM coding guidelines. Specifically, hospices should be doing the following:

  • Including the principal diagnosis and all related diagnoses on hospice Medicare claims
  • Not utilizing adult failure to thrive and debility as the principal diagnosis (CMS expects a more specific diagnosis and will, at some point in the future, return to provider claims with either of these diagnoses as the principal diagnosis)
  • Utilizing the most appropriate specific dementia diagnosis per the ICD-9-CM coding guidelines

The issues surrounding these hospice diagnosis requirements are a “hot topic” for hospice providers. NAHC and its affiliate -- the Hospice Association of America (HAA) -- are hosting a webinar for hospice providers designed to address these issues. Because these issues are of such important to hospices now the webinar is scheduled for June 25, 2013. Detailed webinar and registration information is below.

Deciphering ICD-9-CM Coding Guidelines for Hospices

CMS has said many times that hospices must follow coding guidelines and should be coding more than the one terminal diagnosis. Improved insight into coding guidelines will provide strategies and solutions for compliance with the regulatory mandates from CMS. The timelines for new edits denying primary diagnoses of debility and failure to thrive are unknown but will be announced soon. The education of referring physicians and adapting operations related to monthly claims submission to ensure a smooth transition should be undertaken now. Lisa will discuss the regulatory mandates and add insight into coding in hospice. Upon completion of the webinar, attendees will be able to:

  • Describe how the terminal diagnosis and related diagnoses should be identified.
  • Discuss the CMS decision to prohibit debility and failure to thrive as terminal illnesses and alternatives to debility and failure to thrive.
  • Identify methods to improve compliance with coding guidelines and describe the patient's complex medical needs related to the terminal diagnosis.

About the Presenter: Lisa Selman Holman, JD, BSN, RN, HCS-D, HCS-O, COS-C AHIMA Approved ICD-10-CM Trainer/Ambassador Lisa is a veteran of home care with over 26 years spent in home health and hospice, both as an RN and as an attorney practicing exclusively in home care. She is the owner of Selman-Holman & Associates, LLC (a full-service home care and hospice consulting firm) and CoDR (Coding Done Right), an outsourcing company for home care and hospice coding. Lisa participates on the Board of Medical Specialty Coding and Compliance specialty board on OASIS and is the chair of the specialty board on home care coding. She has provided education to home health and hospice professionals since 1994.

Register Today Online here. Product registration is here.

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CMS is Requiring HIPPS Codes on Medicare Advantage Claims

Effective July 1, 2013 home health agencies will be required to include a Health Insurance Prospective Payment System (HIPPS) code on Medicare Advantage (MA) claims. The Centers for Medicare & Medicaid Services (CMS) has instructed MA organizations to reject any home health claim that does not include a HIPPS code. According to a CMS communication with the health plans, CMS is requiring the HIPPS codes on home health claims in order to accurately price home health encounters.

CMS has not provided any direct communication with the provider community. Several agencies have been informed of this requirement through communications from their contracted MA plans. However, many agencies have not received any communication.

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