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:: NAHC Report
NAHC Report: Issue# 2221, 6/20/2013
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Transitioning to Managed Long-Term Services and Supports
HCTAA Submits Comments on Safe Harbor Provisions
For Your Information: Webinar: Diagnosis Coding for Hospices Deciphered
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Transitioning to Managed Long-Term Services and Supports
CMS and Truven Provide Guidance and Suggestions

On May 21, the Centers for Medicare & Medicaid Services (CMS) issued guidance to states and other stakeholders on the implementation of managed long-term services and supports (MLTSS).  CMS also issued analysis by Truven Health Analytics (Truven) on observations of and suggestions for long term services and supports (LTSS) providers and managed care organizations (MCOs) implementing MLTSS.

In the following brief, the Council reports on CMS’s analysis of what it deemed the “essential elements” of MLTSS programs, and general observations and recommendations that Truven had for LTSS providers implementing MLTSS.

Essential Element #1: Adequate Planning

States must have adequate planning with regards to the design of the MLTSS program, MLTSS readiness and MCO readiness evaluation, and oversight regarding implementation and transition.

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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 so important to hospices, 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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HCTAA Submits Comments on Safe Harbor Provisions

The Home Care Technology Association of America (HCTAA), an affiliate of the National Association for Home Care & Hospice (NAHC), recently filed comment with the Centers for Medicare & Medicaid Services (CMS) and the Office of the Inspector General (OIG) of the Department of Health and Human Services (HHS) regarding corresponding proposed rules for the extension of Electronic Health Records Safe Harbor Under the Anti-Kickback Statute.

NAHC advocated that the home care and hospice industry is committed to the adoption and meaningful use of EHR technology to support new care delivery models that improve patient outcomes and reduce costs. NAHC sent the letters to encourage CMS and OIG to extend the sunset date for the exception under the anti-kickback statute for certain EHR arrangements, maintain the inclusion of home health providers as protected donors under the EHR safe harbor and apply the EHR safe harbor equally to all providers of home health services.

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