In The News

Introducing Post-Acute 2.0: New Services Needed To Deliver Care At Home

Forbes / Ashish V. Shah
Ashish V. Shah is CEO of Dina, an AI-powered care-at-home platform, that supports the industry's transition to virtual and in-home care.
As care continues to move into the home setting, traditional Medicare-approved services like skilled nursing and home health care are no longer enough. Meal delivery, transportation, remote monitoring, in-home care and pest control are just a few examples of the health benefits of the future.
In the next five to 10 years, every home will need to be configured to operate as a formalized care setting (e.g., primary care clinic or hospital), and providers — especially those who are part of value-based contracts — need to be ready to deliver care in this setting.
A major challenge is replicating acute-level care in the home environment: delivering around-the-clock nursing care, continuously monitoring vital signs, supporting nutrition and social well-being needs, and providing just-in-time testing and imaging when needed.
There are other big considerations as well. How do you ensure the home is safe and ready for care? After discharge, what types of modifications are required to help people age in place moving forward? . . .

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Hospice Community Responds to Proposed Survey Reforms in CMS Home Health Rule

Hospice News / By Jim Parker
The National Hospice & Palliative Care Organization (NHPCO) in consultation with its members have submitted comments to the U.S. Centers for Medicare & Medicaid Services (CMS) on hospice provisions within the proposed 2022 home health rule. If made final the rule would overhaul the survey and regulatory enforcement processes that CMS uses to evaluate hospices.
CMS is taking these actions pursuant to the Consolidated Appropriations Act of 2021. Congress included these provisions in response to July 2019 reports on hospice quality from the Office of the Inspector General (OIG) at the Department of Health and Human Services (HHS).
“While the intent of the proposed rule is sound, many of the specifics raise concerns,” said NHPCO’s President and CEO Edo Banach. “NHPCO’s recommended revisions to the proposed rule would protect patient interests, bring hospice regulations in line with regulations governing other post-acute care providers, and improve standardization and consistency in hospice accreditation and surveying systems.”
If made final, the new regulations would require multidisciplinary survey teams, prohibit surveyor conflicts of interest and update the surveyor training process. The agency expects that implementation of these proposals would cost an estimated $5.5 million annually. The rule would also mandate that surveys be conducted more frequently, no later than 36 months following the providers’ previous survey.
Among the numerous elements contained in the proposal is the creation of a Special Focus Program (SFP) with the power to impose enforcement remedies against hospices with poor performance on regulatory or accreditation surveys. The agency also has plans to implement a hospice program complaint hotline through which the public can report issues to CMS.
Hospices flagged by the proposed Special Focus Program would be surveyed every six months rather than the current three-year cycle. The SFP would have the authority to impose fines, suspend reimbursement, appoint temporary management to bring the hospice into compliance, or revoke a provider’s Medicare certification altogether.

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CMS Resumes Targeted Probe and Educate

As reported previously, CMS has announced the resumption of Targeted Probe and Education (TPE) reviews. Although there is not yet much additional information available, we understand that there may be more detail coming from the MACs in the near future.

Until then, checking claim status codes may help providers identify any claims that might be part of TPE reviews. The following reminder is provided by Palmetto but applies to all MACs including CGS:

  • When a claim is selected for possible Targeted Probe and Educate (TPE) review, it will go into an S B6000 location in Direct Data Entry (DDE). When the claim goes to this location there will be narrative that indicates the claim was selected and documentation is requested. However, you should not respond with medical documentation unless the claim moves to S B6001 location. When a claim goes into S B6001 location, it generates an Additional Document Request (ADR) and it will hold in that location until the records are received.
  • Claims initially suspended into location S B6000 may not advance to S B6001 for review and could be released for processing without review. Only claims that are selected for review will move from S B6000 to S B6001. Do not send in medical documentation unless the claim suspends to location S B6001, when the ADR will be generated.
  • However, when and if the claim moves to SB6001 and you need to send in documentation, please refer to your ADR letter to ensure you provide the MAC with the documents needed to process your claim.

Recent Forbes article explores differences in hospice and palliative care

The Forbe's article describes hospice and palliative care, and then offers similarities, differences, and payment methods for each. Finally, the article offers questions to consider when determining which service is best for “your loved one.”

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eHospice features article by NHPCO’s Edo Banach titled “Moving Beyond the Medicare Benefit in the U.S.” 

Banach calls for more flexibility so that people can get curative and palliative care at the same time. He also calls the six months prognosis for hospice eligibility “arbitrary,” saying it has been a financial issue (not a medical one) since the beginning of the Medicare Hospice benefit. It will better serve beneficiaries, he says, if hospice service is based on patient needs and is not a time-limited benefit. Community-based palliative care needs to be defined and implemented.

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