In The News

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.”

Read the Article

 
 

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.

Read the Article 

 

CDC Experts May Not Back Widespread COVID-19 Boosters

“A Centers for Disease Control and Prevention (CDC) advisory panel [last] Monday indicated it could take a substantially different approach to booster doses of COVID-19 vaccines than the one proposed by the Biden administration. Members of the CDC's Advisory Committee on Immunization Practices (ACIP) said the evidence on boosters is not clear and indicated it would likely consider a risk-based approach that would prioritize residents of long-term care facilities and health workers rather than all eligible Americans at once.”

Read more in this article from The Hill.

 

Colorado requiring vaccinations for health care workers

The Hill / Celine Castronuovo

The Colorado Board of Health on Monday voted to implement a vaccine mandate for workers at hospitals, nursing homes and other state health care facilities following a request earlier this month from Gov. Jared Polis (D). 

The board members voted 6-1 in a virtual meeting that all employees, direct contractors and other staff at the roughly 3,800 health care facilities licensed in Colorado must receive their first dose of the vaccine by Sept. 30, according to local ABC affiliate KMGH

Under the measure, which is expected to be finalized by the state health board in October, all health care workers must be fully vaccinated no later than Oct. 31. 

The vaccine mandate will apply to staff members at general hospitals, rehabilitation centers, community health centers, assisted living facilities and other similar locations across the state, The Colorado Sun reported

According to the Colorado Department of Public Health and Environment, roughly 30 percent of health care workers at these facilities are currently unvaccinated. 

Polis in an Aug. 17 letter to the state Board of Health called for a vaccine requirement among health workers due to the rising surge in COVID-19 cases, largely attributed to the spread of the highly contagious delta variant. 

“The pandemic we face today is largely a pandemic of the unvaccinated,” the governor wrote, echoing previous statements on the recent surges from federal health officials. 

“The State can meet this challenge by getting more people vaccinated and protecting those most at risk,” Polis added. “The vaccine is a safe and proven tool to curb the spread of COVID-19 and save lives.”

The governor pushed for the vaccine mandate among health workers following “conversations with both senior living industry leaders, patient advocates and leaders in healthcare.”

“It’s critical that all personnel who are capable of bringing the deadly virus into facilities where our vulnerable populations are in their custody be fully vaccinated in order to save lives,” he added at the time. 

However, opponents to the mandate who spoke at Monday’s board meeting argued that the requirement could fuel staffing shortages, with some workers saying that getting the COVID-19 vaccine should be a personal choice. 

The vote Monday makes Colorado the latest in a series of states to adopt similar vaccine requirements for health workers. 

Both California and New York moved earlier this month to require staff at health care facilities to be fully vaccinated, as well as Illinois, which also implemented a similar mandate for teachers at public schools.

 
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