Delta Connect Blog

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

Home Health and Hospice Open Door Forum Set for July 8

Posted by Crystal Parks on Jun 29, 2015 9:53:34 AM


On Wednesday, July 8, 2015, CMS will host a Home Health, Hospice & Durable Medical Equipment Open Door Forum at 3:30 p.m. Eastern Time.  The agenda includes home health and hospice rule updates, home health star ratings update, information on accessing home health CASPER reports, and publication of the OMB-approved OASIS-C1/ICD-10 data set and final OASIS-C1/ICD-10 manuals. 

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: CMS Open Door Forum, Hospice, Home Health

ICD-9/ICD-10 Dual Coding for Home Health and Hospice

Posted by Crystal Parks on Jun 22, 2015 10:41:56 AM


With ICD-10 codes being required beginning October 1, 2015, home health and hospice providers need to prepare for dual coding prior to the October deadline.  With 60-day episodes for home health and 90-day episodes for hospice, agencies could find themselves in a situation where ICD-9 codes must be used for the start of care OASIS and ICD-10 codes must be used for final claim submissions. 

The first home health 60-day episode that will end on October 1 is August 3, and the first day of a hospice 90-day episode will be July 4.  If the OASIS and the plan of care are created using dual coding, the ICD-10 codes will already be known when the time comes to submit the final claim. Of course, dual coding would take extra time and resources to complete at the start of the episode, so it will be up to each agency to decide what works best.  

Is your home health and hospice organization taking the necessary steps to be ICD-10 compliant?

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Topics: ICD-10

Palmetto GBA Awarded MAC Jurisdiction M by CMS

Posted by Crystal Parks on Jun 18, 2015 6:01:00 PM


CMS has announced that Palmetto GBA will be the A/B Medicare Administrative Contractor (MAC) for Jurisdiction M, formally Jurisdiction 11, beginning on July 13, 2015.  Palmetto GBA will be the administrator for Medicare Part A and Part B Fee-for-Service (FFS) claims as well as the Home Health and Hospice Region C service area. 

Palmetto GBA will be the MAC for Medicare Part A and Part B Fee-for-Service (FFS) claims for the States of Virginia, West Virginia, North Carolina, and South Carolina.  Home Health and Hospice Region C service area includes Alabama, Arkansas, Florida, Georgia, Illinois, Indiana, Kentucky, Louisiana, Mississippi, New Mexico, North Carolina, Ohio, Oklahoma, South Carolina, Tennessee, and Texas.

Providers should not see any change in the MAC's work since Palmetto GA is the incumbent contractor for MAC Jurisdiction 11, the current MAC workload numbers will remain the same. 
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Topics: Home Health Claims, CMS

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