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  NAHC Report: Issue# 2597, 2/3/2015
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An Update on Self-Reporting of Aggregate Caps for Hospices
CMS to Begin Matching OASIS With Claims
For Your Information: NAHC and HHNA’s Nurse Recognition Program Now Seeking 2015 Nominations for the Home Care & Hospice Nurse of the Year
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An Update on Self-Reporting of Aggregate Caps for Hospices

Beginning with the 2014 cap year, hospices are required to self-calculate and report their aggregate cap, along with any cap-related liability, by March 31. Hospices may not calculate the cap prior to January 31. In the final FY2015 payment rule, The Centers for Medicare & Medicaid Services (CMS) indicated its intent to issue a pro-forma spreadsheet and instructions to assist hospices in fulfilling this responsibility.  However, release of the pro forma spreadsheet and instructions has been delayed because the Department of Health & Human Services (CMS) has under legal review consideration of whether the 2% sequester - which affects hospice payments beginning with services provided on or after  April 1, 2013 - should or should not be included in calculation of a hospice’s cap liability. 

This issue was reported by NAHC in early Fall 2014 and discussed during the November CMS Open Door Forum.  The cap/sequester issue is one that NAHC has been working on in conjunction with NHPCO and others for several months.

It is NAHC’s understanding that CMS does not plan on issuing instructions related to self-calculation/reporting of the aggregate cap until the cap/sequester issue is resolved. The timing of such a resolution is not currently known. At this time, however, there is no indication that CMS plans to delay the requirement that hospices must report by March 31. 

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CMS to Begin Matching OASIS With Claims

Beginning on April 1, 2015, Medicare systems will compare the Health Insurance Prospective Payment System (HIPPS) code on a Medicare home health claim to the HIPPS code generated by the corresponding Outcomes and Assessment Information Set (OASIS) assessment before the claim is paid. If the HIPPS code from the OASIS assessment differs, Medicare will use the OASIS-calculated HIPPS code for payment.

Previously, the transmission of assessment data and the submission of claims were entirely separate processes. The Fiscal Intermediary Shared System (FISS), which processes all Original Medicare home health claims, did not have access to the quality data repository. As a result, FISS could not validate the submitted HIPPS code against the associated OASIS assessment.

The Centers for Medicare & Medicaid Services (CMS) has planned for several years to create a file exchange interface with the national quality data repository to provide the infrastructure needed to validate HIPPS codes against OASIS assessments. During 2014, the Medicare Administrative Contractors (MACs) successfully began testing the home health OASIS and claim matching process.

Home health agencies (HHAs) are not required to make any changes to their billing systems.

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NAHC and HHNA’s Nurse Recognition Program Now Seeking 2015 Nominations for the Home Care & Hospice Nurse of the Year
February 14 deadline fast approaching

NAHC and its affiliate the Home Healtcareh Nurse’s Association is seeking nominations for the 2015 Nurse of the Year. NAHC runs the Home Care & Hospice Nurse of the Year campaign to further recognize a nurse who stands for the highest standards of care. The top 10 nurses chosen by the selection committee will be eligible for the Nurse of the Year award. Then the final decision falls to NAHC members and the public. Voting begins this summer on the NAHC website, and the winner will be announced at the 2015 NAHC Annual Meeting in October.

Eligibility Requirements

Any registered nurse currently employed by a NAHC member agency is eligible for the Nurse Recognition Program. The nominated nurse should embrace the program’s spirit and exhibit the following attributes:

  • Does the nurse’s story paint a positive picture of home care and hospice?
  • Does the story show that the nurse provided exceptional care?
  • Does the applicant demonstrate excellence in nursing through credentials, awards, and honors?
  • Did the applicant make a difference in their patients’ lives?
  • Did the applicant inspire us to be our best?

Special Cases

Agencies may nominate telemonitoring nurses who do not visit patients or hospice nurses whose patients are deceased. In these cases, it may not be possible to obtain a photo that depicts the nurse with the patient. If so, agencies may submit separate photos of the patient and the nurse, but photo release forms are still required for a nurse’s story to appear in CARING. If the patient is deceased, or if they are a minor, an adult family member may complete and sign the release form.

Online Application

Each nomination must be submitted using the online form available on the NAHC and HHNA websites. Use the online form to provide background information on the nurse, along with contact information for the agency and the nurse. Please provide separate contact information for nurses who do not work out of the agency’s central office.

For more information on the Nurse of the Year program and submission guidelines, please click here.

Director of Finance. VNA Care Network & Hospice, Inc., Southborough, MA

Reporting to the Chief Financial Officer/Chief Operating Officer the Director of Finance will oversee and actively participate in the accounting, budgeting, cost reporting, accounts payable, billing and cash flow systems of the Network and affiliates. BS Accounting required, MBA and CPA preferred. Minimum 4  years of experience in Home Health financial management and experience in personal computer spreadsheet applications.

Please forward your resume and cover letter with salary requirements to Ann Bohac, HR Recruiter VNA Care Network & Hospice at or visit our website at


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