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:: NAHC Report
 
  NAHC Report: Issue# 2772, 10/19/2015
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ARTICLE ARCHIVES MEMBER RESOURCES eNEWSLETTERS CARING STORE
CMS Issues G-Codes to Differentiate RN and LPN visits for Hospice, Home Health
Updates to CMS Program Integrity Manual
For Your Information: Benefit Luncheon at NAHC Annual Meeting
Job Corner: Assistant Vice President, Home Health/Hospice – Full Time
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CMS Issues G-Codes to Differentiate RN and LPN visits for Hospice, Home Health
Different Codes for RN/LPN Visits will Facilitate Implementation of Hospice Payment Reforms

On Friday, October 16, 2015, the Centers for Medicare & Medicaid Services (CMS) issued Transmittal 3378/Change Request 9369, providing Additional G-Codes Differentiating Registered Nurses (RNs) and Licensed Practical Nurses (LPNs) in the Home Health and Hospice Settings. The issuance of these two new codes, G0299 for RNs and G0300 for LPNs, was necessary so that, beginning with hospice services provided on or after January 1, 2016, CMS can appropriately pay hospices for RN visits during the last seven (7) days of life in the Routine Home Care (RHC) setting when those visits are eligible for the Service-Intensity Add-on (SIA). These two G-codes will be applicable effective for hospice dates of services on and after January 1, 2016, and for home health episodes of care ending on or after January 1, 2016; with the institution of the new codes the existing “G0154 -- Direct skilled nursing services of a licensed nurse (LPN or RN) in the home health or hospice setting” will be retired.

CR 9369 modifies the hospice chapter of the Medicare Claims Processing Manual to require use of the two new G-codes (with retirement of G-0154) and to correct the existing example for the two-tiered RHC payment system as the example issued as part of CR 9201 was incorrect relative to the day counts (it did not take into consideration that 2016 is a leap year). CR9369 also provides additional claims submission detail over the example for the SIA provided in CR 9201 to reflect the newly-established G-codes. The home health chapter of the Medicare Claims Processing Manual has been modified as part of CR 9369 to reflect the addition of the two new G-codes and retirement of G-0154.

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Updates to CMS Program Integrity Manual

CMS posted Change Request (CR) 9226 effective November 17, 2015.  This CR is a clarification in operational procedures for CMS contractors and updates Chapter 3 of the Program Integrity Manual. In some instances, the contractors (MACs, CERT, Recovery Auditors, and Zone Program Integrity Contractors (ZPICs)) may not be able to make a determination on a claim they have chosen for review based upon the information on the claim, its attachments, or the billing history found in claims processing system (if applicable) or the Common Working File (CWF). In those instances, the reviewer shall solicit documentation from the provider or supplier by issuing an additional documentation request (ADR).

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Benefit Luncheon at NAHC Annual Meeting

We invite you to attend the annual Caring Awards Ceremony, on Friday October 30th at 10:30 am in Delta Ballroom A, Gaylord Opryland Resort. Following the ceremony, we will be honoring the 10 Caring Awardees at a Benefit Luncheon. You can purchase a ticket for the luncheon online. (Inquiries: 202-547-4273 or info@caring.org)

The Caring Institute is a 501 C (3) nonprofit organization established to promote the acts and values of caring, integrity, and public service.

 

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