Delta Connect Blog

One Month Until ICD-10 - Are you Ready?

Posted by Crystal Parks on Aug 31, 2015 1:59:17 PM



ICD-10 implementation is only a month away. How ready is your home health and/or hospice organization for ICD-10?  

By now, your agency should:

  • Have the ICD-10 compliant version of your home health and/or hospice vendor(s) software in production;
  • Completed, are in the process of, or will soon be testing with your applicable payers;
  • Be dual coding;
  • Continuing intensive training for coders; and
  • Reviewing your ICD-10 Project Plan to be sure all tasks are completed for full compliance of ICD-10.

Visit the CMS ICD-10 website for the latest news and resources to help you prepare for the October 1, 2015, deadline.

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Topics: ICD-10

2015 Home Health Grouper Impacted by Recent ICD-10 Guidance

Posted by Crystal Parks on Aug 21, 2015 1:41:26 PM

ICD10 Guidelines for Home Health 

The National Association for Home Care & Hospice (NAHC) has recently learned that the organizations responsible for the official 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.

Experts have understood that an "A" would never be appropriate as the 7th character for a home health diagnosis. The reason being is the patient would have been seen initially in another setting. But, the initial encounter definition in the ICD-10 coding guidelines is broader than experts 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.”

“For complication codes, active treatment refers to treatment for the condition described by the code, even though it may be related to an earlier precipitating problem. For example, code T84.50XA, Infection and inflammatory reaction due to unspecified internal joint prosthesis, initial encounter, is used when active treatment is provided for the infection, even though the condition relates to the prosthetic device, implant or graft that was placed at a previous encounter.”

The 2015 Home Health Grouper does not allow for case mix and non-routine supply points for any ICD-10 code with an "A" as the 7th character. 

NAHC is currently waiting for confirmation from CMS on how this issue will be addressed. Since it is unlikely that the Home Health Grouper can be updated this close to the ICD-10 implementation date, claims may need to be adjusted.

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Topics: ICD-10, Home Health

Update on Final FY2016 Hospice Rule

Posted by Crystal Parks on Aug 12, 2015 11:21:35 AM

register for hospice webinar

During a webinar on Tuesday, August 18, NAHC will explore hospice policy changes CMS finalized in recent weeks and provide a comprehensive update of CMS' plans and timelines for implementing reform of the hospice payment system.  During the webinar changes related to the inpatient and aggregate Caps, the Hospice Quality Reporting Program (HQRP), and diagnosis coding on claims will also be discussed. 

The objectives of the webinar are:

  • Describe key elements of CMS' planned revisions to the payment system for Routine Home Care (RHC)
  • Outline changes affecting hospice payment CAP monitoring and reporting
  • Discuss various aspects of the Hospice Quality Reporting Program and anticipated future activities
  • Explain CMS' clarification regarding diagnosis coding on hospice claims

The webinar is scheduled from 1:00 - 2:00 p.m. Eastern Time.  

Hospice providers may register for the webinar via the NAHC Online Store. Registration is free for NAHC members and $150 for non-members. 

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Topics: National Association for Home Care and Hospice, NAHC, Hospice

Home Health PEPPER Available

Posted by Crystal Parks on Jul 20, 2015 9:29:45 AM



TMF® Health Quality Institute (TMF) released the Hospice PEPPER in June 2015.  Today, the Program for Evaluating Payment Patterns Electronic Report (PEPPER) for home health agencies will be made available.  

The free PEPPER summarizes home health claims statistics for areas that may be at risk for improper Medicare payments and compares an agency's Medicare billing practices with other agencies in the nation, MAC jurisdiction, and state. 

The home health PEPPER contains claims data statistics for:

  • Average case mix
  • Average number of episodes
  • Episodes with 5 or 6 visits
  • Non-Low Utilization Payment Adjustment (LUPA) payments
  • High therapy utilization episodes
  • Outlier payments

On July 30, a WebEx training session introducing and reviewing the PEPPER will be held. Registration is not required. More information may be found here

To access the PEPPER report, click here.  A home health PEPPER User's Guide with instructions for accessing the report is available here.  

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Topics: Home Health

2016 Home Health PPS Proposed Rule Released

Posted by Crystal Parks on Jul 7, 2015 9:05:00 AM

Home Health PPS Proposed Rule


CMS released the FY 2016 Home Health Proposed PPS rule on July 6, 2015. The rule proposes to establish a value-based purchasing program in nine states for home health providers in 2016. According to CMS, providers in the affected states would have payments adjusted depending on the degree of quality performance achieved. Payments would change by 5% in each of the first two payment adjustment years, 6% in the third year, and 8% in the final two years. The value-based purchasing program would be implemented January 1, 2016 and end December 31, 2022. 

Other major provisions of the rule are:

  • CMS is moving forward to implement the third year of the four-year phase-in of the rebasing adjustments to the Home Health PPS. As finalized in the CY14 final rule, the CY16 downward adjustment is $80.95.
  • CY16 will be the second year that CMS proposes to annually recalibrate the Home Health PPS case-mix weights. This is identical to CY15.
  • CMS proposes to decrease the national, standardized 60-day episode payment amount by 1.72 percent in each of CY16 and CY17 to account for nominal case-mix coding intensity growth unrelated to changes in patient acuity between CY12 and CY14.
  • CMS will also be updating the Home Health PPS payment rates by 2.3 percent in CY16.
  • CMS proposes to establish a threshold for submission of OASIS assessments.
  • CMS proposes a new quality measure that addresses the domain of skin integrity and changes in skin integrity. The IMPACT Act requires the specification of such a quality measure by Jan. 1, 2017.

CMS will host an Open Door Forum to review the rule on tomorrow at 3:30 PM Eastern Time. To participate, dial 1-800-837-1935 at least 15 minutes prior to the start time of the forum and enter conference ID: 21624265. Click here for the full agenda for the July 8th meeting.

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Topics: home health prospective payment system, CMS

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Recent Delta Blogs

One Month Until ICD-10 - Are you Ready?
Update on Final FY2016 Hospice Rule
Home Health PEPPER Available