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  NAHC Report: Issue# 2731, 8/20/2015
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ICD-10 Guidance Impacts 2015 Home Health Grouper
CMS Releases Change Request 9201 – Instructions Pertaining to Hospice Payment Reform Effective January 1, 2016
For Your Information: Housing Update for 2015 Annual Meeting
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ICD-10 Guidance Impacts 2015 Home Health Grouper

The National Association for Home Care & Hospice (NAHC) has recently learned that the organizations responsible for the official International Classification for Disease (ICD)-10 coding guidance has issued clarification that would require home health agencies to indicate an “A” (initial encounter) in the 7th character for some ICD-10 codes. An “A” in the 7th character should be used for any encounter where the patient is still receiving active treatment for the clinical condition, including home health. While in many cases this would not apply to home health, there are times where it could, such as antibiotic treatment for a postop infection.

Until now both home health coding experts and CMS have understood that an “A”- initial encounter” would never be appropriate as the 7th character for a home health diagnosis since the patient would have always been seen initially in another setting. However, the definition of initial encounter in the ICD-10 coding guidelines is broader than many realized.

In the ICD-10-CM Official Guidelines for Coding and Reporting, the following language is used to help coders determine when an “A” should be used in the 7th character:

“While the patient may be seen by a new or different provider over the course of treatment for an injury, assignment of the 7th character is based on whether the patient is undergoing active treatment and not whether the provider is seeing the patient for the first time.”

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CMS Releases Change Request 9201 – Instructions Pertaining to Hospice Payment Reform Effective January 1, 2016

CMS released Change Request (CR) 9201 which corresponds to the payment changes that are part of Medicare’s FY 2016 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements (the final rule). For more information on the final rule see the August 3, 2015 edition of NAHC Report. The CR is dated August 14, 2015, but was not posted until August 20, 2015. The CR updates the Medicare Claims Processing Manual, Chapter 10 effective January 1, 2016.

The CR implements service intensity add-on (SIA) payments for hospice social worker and nursing visits provided during the last 7 days of life when provided during routine home care. In addition, this instruction will implement two routine home care rates, paying a higher rate in the first 60 days of a hospice election and a lower rate for days 61 and later.

For the SIA payments, CMS will obtain new codes to distinguish between RN services and LPN services since the existing codes do not make this distinction. CMS expects to obtain these new codes as soon as January 1, 2016.

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Housing Update for 2015 Annual Meeting

Plan to arrive in Nashville on Wednesday, October 28, for NAHC’s Annual Meeting. The first education sessions start on Wednesday afternoon at 4:30pm. Guest rooms in the NAHC block at the host hotel are available Wednesday through Saturday.

To register for the conference and reserve your room, click here.

Referral Center Registered Nurse

The Visiting Nurse Association of Greater Philadelphia is the largest and oldest provider of hospice and home care in the Philadelphia region.

Position Summary:

Responsible for management of the clerical and clinical operations of the Intake Department.  Responsible for making clinical judgments regarding referral requests received by the Intake Department .Assists in planning and arranging for patient care needs in home or community based settings on a comprehensive basis. Initiates contact and follow up calls with referral sources to assure completeness on individual patient referrals, and educates referral sources on the VNA’s mission and full range of home and community health services. 


  • Two years professional level health care experience with a knowledge base of all aspects of home care.
  • ICD-10 training required
  • Knowledge of needs and requirements of third party payers, including Medicare, Medicaid and others.
  • Ability to identify unmet needs and match them with appropriate services in a complex clinical and financial environment.
  • Proficient in Computer Software Programs
  • PA Registered Nurse Licensure.
  • Flexibility of schedule- Will require some evening hours
  • BS in Nursing required

Candidates please submit a resume to or via fax to 215-878-9529.


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