Volume 24.14
The Centers for Medicare & Medicaid Services (“CMS”) has announced that prepayment medical review will be expanded in California, Arizona, Texas, and Nevada. The expansion will reach existing providers; however, a small sample of claims will be reviewed followed by individual education as necessary.
These states have been subjected to a Provision Period of Enhanced Oversight (“PPEO”) for new providers since July 2023. Additional information from CMS will be forthcoming.
NAHC AND NHPCO ANNOUNCE NEW NAME FOR COMBINED ORGANIZATION
The National Association for Home Care & Hospice (“NAHC”) and the National Hospice and Palliative Care Organization (“NHPCO”) have announced that the combined organization will be known as the National Alliance for Care at Home (“the Alliance”). The new website is available at www.allianceforcareathome.org.
HOPE TOOL RELEASED
CMS has released the new Hospice Outcomes and Patient Evaluation (“HOPE”) assessment tool, guidance materials and related information.
Until September 30, 2025, CMS will continue to collect data only at admission and discharge from hospice via the existing Hospice Item Set (“HIS”). This data is used to calculate measures for the Hospice Quality Reporting Program (“HQRP”). However, while the HIS is a standardized mechanism for abstracting medical record data, it is not a patient assessment tool because HIS data are not collected during a patient assessment. Instead, HIS focuses on whether hospices have performed care processes using retrospective data from chart abstraction. CMS’ goal for HOPE is to be more comprehensive than HIS by capturing patient and family care needs in real-time and at additional timepoints during the hospice stay with the flexibility to accommodate patients with varying clinical needs.
Beginning October 1, 2025, HOPE will collect quality data by introducing additional timepoints, referred to as the HOPE Update Visits (HUVs). The HUVs enable CMS to gather patient level data during the first 30 days after a beneficiary elects hospice. Hospice providers will be required to submit up to two HUVs, each at specified timeframes, depending on the length of the hospice stay. HOPE takes into consideration the hospice workflow and the Medicare Conditions of Participation. Data on patients’ baseline status and changes in their outcomes collected via HOPE will contribute to care planning, inform quality measurement for the HQRP, and support providers’ quality improvement efforts.
Information is available at https://www.cms.gov/medicare/
2024 HOSPICE FINANCIAL ADMINISTRATION CONFERENCE – SOON
The 2024 Hospice Financial Administration Conference is scheduled for September 30 – October 1, 2024, at the Hilton Phoenix Tapatio Cliffs Resort in Phoenix, Arizona. Due to current registrations and the limited number of attendees accepted, contact us if you want to register to make certain we can accommodate you. On-site registrations are not accepted.
Speakers include professionals of The Health Group, LLC, Melinda Gaboury, co-founder and CEO of Healthcare Provider Solutions, Inc., and Bryan S. Bailey, Shareholder with Milligan Lawless (Phoenix office) who practices in healthcare fraud and abuse. Registration and other information are available at https://healthgroup.com/
ADDRESS CHANGE
Effective September 3, 2024, The Health Group, LLC has relocated our offices to 400 Fort Pierpont Drive, Suite 202, Morgantown, WV 26508.