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:: NAHC Report
NAHC Report: Issue# 2222, 6/21/2013
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Senator Joe Donnelly Becomes First Democratic Cosponsor of Bill Changing “Full-Time Employee” to 40 Hours Under the ACA
Update on HIPPS codes on MA plan Claims
For Your Information: Webinar: Diagnosis Coding for Hospices Deciphered
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Senator Joe Donnelly Becomes First Democratic Cosponsor of Bill Changing “Full-Time Employee” to 40 Hours Under the ACA

Senator Joe Donnelly (D-IN) joined with Senator Susan Collins (R-ME) earlier this week to support the “Forty Hours Is Full Time Act of 2013,” S. 701. Senator Donnelly becomes the first Democrat to sponsor the legislation, which would modify the definition of full-time employee (FTE) for purposes of the shared responsibility mandates in the Patient Protection and Affordable Care Act (PPACA). 

Starting in 2014, the PPACA currently imposes a $2,000 employer penalty for each full-time employee - after the first 30 - where the business employs 50 or more full time equivalent employees, does not offer health insurance to all employees, and at least one of the employees qualifies for a federal subsidy to purchase health insurance. The definition of “full-time employee” in the calculation of target employer’s penalty is based upon the total of the number of employees working at least 30 hours a week. 

S. 701 would change the definition of full-time employee to those working at least 40 hours a week rather than 30.  This would affect both the determination of whether the employer is a “large employer” subject to the mandate and the number of employees for whom the employer would have to provide health insurance or pay a penalty. 

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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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Update on HIPPS codes on MA plan Claims

In a conference call with CMS officials earlier this week, NAHC learned that although the MA plans have been instructed to include a HIPPS codes on claims effective July 1, 2013, the edits for this requirement will not be turned on until sometime in September. CMS will get back to NAHC with a firm date as to when exactly. At least for the short term there will be no payment consequence for MA plans that do not submit a HIPPS code for home health services, and therefore home health claims should not be held up either.

CMS expects the HIPPS code to be entered on claims the same as with Fee for Service Medicare. We do urge the providers and their vendors to begin the necessary changes to their software systems to be ready for when the firm compliance date is announced. We also urge you to contact your health plans to determine what specifically they are, or are not, requiring related to including the HIPPS code on claims.

We are seeking feedback on whether agencies and vendors can alter their systems in time for September.

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