CMS Finalizes Calendar Year 2021 Payment and Policy Changes for Home Health Agencies and Calendar Year 2021 Home Infusion Therapy Benefit
The increase reflects the effects of the 2% home health payment update percentage and a 0.1% decrease in payments due to reductions in the rural add-on percentages mandated by the Bipartisan Budget Act of 2018 for 2021, the agency noted.
Not many changes this year on the rule due to Covid 19
Biggest changes for 2021
- Raps will not be paid any longer. They will process with $0 Payment but must be submitted and the Final for the 30 days will pay at 100% of the Episode Payment.
- Raps must be submitted within 5 days of admission. For every day after 5 days, agencies will suffer 1/30th of the 30 day payment. For example. If a Rap is submitted on day 7 of the admission, 1/7th of the payment will be reduced at the time of final. If the Rap is submitted on day 10 of the episode, the agency will suffer 10/30th of the payment (which is 1/3 of your episode) This is very costly to the agency if they are not organized and sending Raps timely.
- It is very important to understand what the agencies procedures to be able to submit a RAP as not all documentation is necessary as before in 2020. Since the RAP can be submitted with a “FAKE HIPPS” , the OASIS does not have to be completed to be able to send the Rap. The Notice of Admission requires much less information come 2021.
Standard 30-day period payment
CMS does not make any behavioral adjustments or changes due to the newness of the PDGM and the ongoing COVID-19 pandemic. The national standardized amount for CY 2021 is $1,911.87.
HHS to Begin Immediate Delivery of Initial $30 Billion of CARES Act Provider Relief Funding
Today, the Department of Health and Human Services (HHS) is beginning the delivery of the initial $30 billion in relief funding to providers in support of the national response to COVID-19 as part of the distribution of the $100 billion provider relief fund provided for in the Coronavirus Aid, Relief, and Economic Security (CARES) Act recently passed by Congress and signed by President Trump.
The $100 billion of funding will be used to support healthcare-related expenses or lost revenue attributable to coronavirus and to ensure uninsured Americans can get the testing and treatment they need without receiving a surprise bill from a provider. The initial $30 billion in immediate relief funds will begin being delivered to providers today.
Recognizing the importance of delivering the provider relief funds in a fast, fair, and transparent manner, this initial broad-based distribution of the relief funds will go to hospitals and providers across the United States that are enrolled in Medicare. Facilities and providers are allotted a portion of the $30 billion based on their share of 2019 Medicare fee-for-service (FFS) reimbursements. These are payments, not loans, to healthcare providers, and will not need to be repaid.
HHS and the Administration are working rapidly on additional targeted distributions to providers that will focus on providers in areas particularly impacted by the COVID-19 outbreak, rural providers, and providers of services with lower shares of Medicare FFS reimbursement or who predominantly serve the Medicaid population. This supplemental funding will also be used to reimburse providers for COVID-19 care for uninsured Americans.
HHS is partnering with UnitedHealth Group (UHG) to deliver the initial $30 billion distribution to providers as quickly as possible. Providers will be paid via Automated Clearing House account information on file with UHG, UnitedHealthcare, or Optum Bank, or used for reimbursements from the Centers for Medicare & Medicaid Services (CMS). Providers who normally receive a paper check for reimbursement from CMS will receive a paper check in the mail for this payment as well, within the next few weeks.
Within 30 days of receiving the payment, providers must sign an attestation confirming receipt of the funds and agreeing to the terms and conditions of payment. The portal for signing the attestation will be open the week of April 13, 2020 and will be linked from hhs.gov/providerrelief.
UnitedHealth Group will donate all fees for the administration of the CARES Act provider relief fund.
Visit hhs.gov/providerrelief for additional information.
EXPANSION OF THE ACCELERATED AND ADVANCE PAYMENTS PROGRAM FOR PROVIDERS AND SUPPLIERS DURING COVID-19 EMERGENCY
In order to increase cash flow to providers of services and suppliers impacted by the 2019 Novel Coronavirus (COVID-19) pandemic, the Centers for Medicare & Medicaid Services (CMS) has expanded our current Accelerated and Advance Payment Program to a broader group of Medicare Part A providers and Part B suppliers. The expansion of this program is only for the duration of the public health emergency. Details on the eligibility, and the request process are outlined below. The information below reflects the passage of the CARES Act (P.L. 116-136).
An accelerated/advance payment is a payment intended to provide necessary funds when there is a disruption in claims submission and/or claims processing. These expedited payments can also be offered in circumstances such as national emergencies, or natural disasters in order to accelerate cash flow to the impacted health care providers and suppliers. CMS is authorized to provide accelerated or advance payments during the period of the public health emergency to any Medicare provider/supplier who submits a request to the appropriate Medicare Administrative Contractor (MAC) and meets the required qualifications.
PDGM-Patient Driven Grouper Model. Biggest change in 20 years.
In November 2018, CMS finalized a new case-mix classification model, the Patient-Driven Groupings Model (PDGM), effective beginning January 1, 2020. The PDGM relies more heavily on clinical characteristics and other patient information to place home health periods of care into meaningful payment categories and eliminates the use of therapy service thresholds. In conjunction with the implementation of the PDGM, there will be a change in the unit of home health payment from a 60-day episode to a 30-day period.
- Interactive Grouper tool on HHA Center webpage
- PDGM Case Mix Weights and LUPA Thresholds [ZIP, 45KB] and PDGM Agency Level Impacts [ZIP, 938KB]
- CY 2019 Home Health Final Rule on Federal Register
- MLN Matters Article MM11081- PDGM – Split Implementation
- PDGM – Split Implementation – Change Request 11081
- Home Health Patient-Driven Groupings Model National Provider Call – February 12, 2019
Review Choice Demonstration
Illinois Started in June 2019.
Initial Choices are the following:
- Pre-claim review: 90% approval in 6 months to be removed
- Postpayment review:90% approval in 6 months to be removed
- Minimal postpayment review with a 25% payment reduction. (Could bring additional oversight) Not recommended
CMS will continue to post updated information on this website. In addition, CMS and Palmetto GBA will provide at least 60 days’ notice prior to the demonstration start date in each of the additional four states. CMS will provide notice on this website before phasing in the other demonstration states: Ohio, Texas, North Carolina, and Florida. Please send any questions to: homehealthRCD@cms.hhs.gov.
Claims Issues Log
Medicare realized they have been paying incorrectly Home Health Claims. Your Home Health Billing Services Company “Synergy Consulting” is able to find the claims where Medicare owes reimbursement.
Medicare will correct the Home Health Billing Claims.
Medicare contractors have identified two incorrect payment calculations affecting home health claims. Claims reporting Health Insurance Prospective Payment System (HIPPS) codes are receiving an incorrect case-mix weight that results in underpayment. Also, certain claims that would be eligible to be paid low utilization payment adjustment (LUPA) add-on amounts are not receiving the add-on payment. CMS expects Medicare systems to be corrected soon. Home health agencies do not need to take any action. Medicare Administrative Contractors will adjust the claims to correct payments.
Home Health Medicare Billing Agencies Time for Cost Reports Again
Congressional Letter Opposing Face-to-Face Documentation Requirements Sent to CMS’ Administrator
Home Health Medicare Billing Agencies Time for Cost Reports Again. They are due by June 1 of this year. You can request from Synergy Consulting to retrieve your PS and R (Provider Statistical Reports) from the CMS Portal login.
Make sure that your CPA has your PS & R. If not you will need to gain access to your IACS account to run your PS & R. IF you need assistance in creating IACS account. Please contact us at Synergy Consulting – Your Home Health Billing Services Company.
We recently updated the filing location of JM provider cost reports. All JM Part A and JM Home Health and Hospice (JM HHH) providers and corresponding home offices should now file their cost reports to the Columbia, South Carolina office location. Cost report reminder letters will be updated to reflect the change in filing location. These letters are sent approximately 37 days before the cost report is due.
Checks and correspondence relating to amounts due on cost reports should be mailed separately. This address is provided below as well.
Cost Report Address Information – Columbia, South Carolina.
For Cost Reports and Supporting Information
Mailing Address for U.S. Mail Palmetto GBA
Attn: Cost Report Acceptance (AG-330)
P.O. Box 100144
Columbia, SC, 29202-3144
Mailing Address for Courier Service Palmetto GBA
Attn: Cost Report Acceptance (AG-330)
2300 Springdale Drive, Bldg. One
Camden, SC 29020