May Insights and Critical Updates (V.3)

May Insights and Critical Updates (V.3)

CHAP is always seeking resources and insights to enhance the knowledge of partners and customers. 

Be sure to download CHAP’s Compliance calendars for home health and hospice. 

Hospice Updates 

Hospice: New Requirement for Physicians Who Certify Patient Eligibility Effective June 3 

For Medicare to pay for hospice services, the following physicians must enroll in Medicare or opt-out by June 3, 2024: 

  1. The hospice medical director or the physician member of the hospice interdisciplinary group who certifies the patient’s terminal condition 
  1. Patient-designated attending physician (if they have one) who certifies their terminal condition 

CMS will deny hospice claims if the certifying physician isn’t in our PECOS hospice ordering and referring files by then.  If a physician is currently enrolled or opted out, you don’t need to do anything.  This new requirement: 

  • Only applies to Fee-for-Service Medicare 
  • Doesn’t prohibit the patient’s independent attending physician from treating them while in hospice and billing for these services under Part B 
  • Applies to all written or oral certifications under § 418.22(c)  

Hospices can quickly verify a physician’s enrollment or opt-out status using the CMS ordering and referring data file, which lists all Medicare-enrolled and opted-out physicians. 

More Information: 

HQRP Update 

The HQRP Quarterly Q&A for Q1, 2024 is now available. This Q&A includes selected questions received by the Hospice Quality Help Desk during the first quarter of 2024 (Jan. 1 to Mar. 31). A link to the document can be found in the Downloads section of the HQRP Requirements and Best Practices page. 

Updated Quick Reference Guide Available  

An updated Quick Reference Guide is now available in the Downloads section of the Requirements and Best Practices webpage. The Quick Reference Guide provides high-level information on the Hospice Quality Reporting Program, including frequently asked questions and helpful links. 

Link Identified Between Hospice Provider Volume and Quality of Care in Assisted Living Facilities 

Hospice providers serving more assisted-living patients tended to receive lower-quality ratings than those caring for fewer patients, according to an AHRQ-funded study in the Journal of the American Geriatrics Society. Researchers based their findings on AHRQ’s Consumer Assessment of Healthcare Provider and Systems (CAHPS) Hospice Survey, which assesses the experiences of hospice patients who subsequently die and their caregivers. They found that among high-volume assisted-living hospice providers, quality was lower across several domains including pain assessment, dyspnea treatment, emotional support, team communications and family care training. Access the abstract

Home Health Updates 

CY 2025 Home Health Prospective Payment System Rate Update and Home Infusion Therapy and Home IVIG Services Payment Update (CMS-1803) 

This proposed rule is currently at the Office of Management and Budget for review and approval.  CHAP will communicate when the rule is published in the Federal Register. 

Home Health Claims: Additional Enforcement of Required County Codes 

Effective October 1, 2024, you must report county codes (value code 85) on all home health claims with type of bill 032x.  

More Information: 

Updated Quick Reference Guide Available 

An updated Quick Reference Guide is now available in the Downloads section of the  Home Health Quality Reporting Requirements webpage. The Quick Reference Guide provides high-level information on the Home Health Quality Reporting Program, including frequently asked questions and helpful links. 

DME Updates 

DMEPOS: Updated List of Items Potentially Subject to Conditions of Payment 

CMS updated the DMEPOS Master List

  • Added 76 items 
  • Deleted 3 items 

If these items are selected for a face-to-face encounter, written order before delivery, or prior authorization, you may be required to: 

  • Meet with your patient and give them a written order before delivering the item 
  • Ask your Medicare Administrative Contractor to authorize the item in advance 

Learn more about extra order requirements: 

See CHAP Blog 

Lymphedema Compression Treatment Items: New DMEPOS Benefit Category 

Starting January 1, 2024, Medicare pays for lymphedema compression treatment items for Medicare Part B patients. CMS updated the following manuals with information on this new DMEPOS benefit category: 

All Provider Updates 

CMS extends Medicaid waivers to 2025  
CMS will extend flexibilities designed to help states keep more eligible individuals enrolled in Medicaid through June 2025. The waivers, previously set to expire at the end of 2024, will be extended for six more months. 

Read the notice – 

CMS Compliance Resource 

The Provider Compliance Tips tool provides high-level guidance on how to prevent claim denials and highlight documentation requirements for claim submission. It focuses primarily on services with high improper payment rates and is published by the Center of Medicare (CM) and posted to the Medicare Learning Network (MLN). This educational tool offers Medicare provider compliance tips to help providers order and bill items and services for eligible patients and meet medical necessity requirements. 

This Provider Compliance Tips tool offers coverage compliance information for different covered services and supplies,  such as: 

  • Affected Providers 
  • HCPCS & CPT Codes 
  • Billing Denials & Preventing Them 
  • Durable Medical Equipment Prosthetics, Orthotics, and Supplies (DMEPOS) General Documentation Requirements 
  • Resources 

Diabetic Shoes: Prevent Claim Denials 

In 2022, the improper payment rate for diabetic shoes was 51%, and insufficient documentation accounted for 69% of improper payments (see 2022 Medicare Fee-for-Service Supplemental Improper Payment Data (PDF), Appendices D, E, and G). Learn how to bill correctly for these services. Review the diabetic shoes provider compliance tip for more information, including: 

  • Codes 
  • Coverage limitations and requirements for therapeutic shoes 
  • Documentation requirements and example of improper payment 
  • Resources 

FDA Update 

The FDA provided an update on our ongoing evaluation of quality and performance issues related to plastic syringes made in China. Specifically, the FDA announced an import alert for Zhejiang Longde Pharmaceutical Co. Ltd. and Shanghai Kindly Enterprise Development Group Co. Ltd. for not meeting device quality system requirements, to prevent plastic syringes made by these China-based manufacturers from entering the U.S. Additionally, the FDA recommendations have been updated to include that users should also immediately transition away from using plastic syringes made by these manufacturers, unless use of these syringes is absolutely necessary until the transition to syringes that are not manufactured in China is complete. 

Safe Charging of Medical Devices 

the FDA provided information on how to safely charge hearing aids, glucose monitors, insulin pumps, and other medical devices to avoid overheating. Medical devices with rechargeable batteries meet important medical needs, but if they are not charged properly, they can overheat, which may result in fires, or cause minor injuries or serious burns.   

Register for virtual attendance at the 2024 CMS Health Equity Conference 

Can’t make it to Bethesda, Maryland, for the 2024 CMS Health Equity Conference on May 29-30? You can still register for virtual attendance! Virtual registration will remain open until May 14. 

As a virtual attendee, you’ll have full access to all the plenary and breakout sessions at the conference from the comfort of your own home. You won’t want to miss the opportunity to experience these highlights from Day 2 of the conference.  You can view the full agenda on the conference website.  

Congress Earmarks $12.5 Million for Palliative Care Research 

Federal lawmakers recently allocated millions of dollars to fuel palliative care research efforts. The move is anticipated to expand palliative education and career development opportunities as demand rises in coming years. 

Congress recently passed the 2024 Labor Labor, Health and Human Services, and Education, and Related Agencies Appropriation Bill. Introduced in July 2023, the appropriation included $12.5 million in funding to “focus, expand and intensify” palliative care research and workforce development efforts, the bill’s language stated. 

Read the article –