April 17, 2017 Edition of The Situation Report Published on Apr 9, 2017

LIVE-IN CASE

SEPSIS

AWARDS

OMIG

New Court decision impacts 24-hour, live-in cases; HCA to hold 4/20 conference call with members to discuss.

HCA reminds members that the sepsis tool is now available for use. Please be sure to sign the user agreement today.

HCA is thrilled to announce the winners of our annual awards, including the Caring, Advocacy and Ruth F. Wilson Awards.

OMIG releases its 2017-18 work plan identifying focus areas for audits and compliance, including areas of concentration for home care, MLTC.

PAGE 5

PAGE 6

PAGE 7

PAGE 9

Your Source for HOME CARE News, Policy and Advocacy

Vol. 2, Issue 16 | April 17, 2017

COMING UP Rediscover, Reimagine, Reinvent at HCA’s Annual Conference in Saratoga Saratoga Springs, NY May 3 to 5 Moving Beyond Personal Care to Meet the Challenge & Opportunities of Value-Based Care New York City, NY May 18, 2017 For more information on these and other programs, please visit the education and events section of HCA’s website at http://hca-nys.org/ events-education/ upcoming-events

National Experts in Palliative Care Featured at HCA Annual Conference May 3-5 Palliative care enhances patients’ satisfaction, quality of care and outcomes, and it reduces costs: all aspects of the “Triple Aim.” Yet studies show that palliative care is also underutilized.

HCA’s Annual Conference on May 3 to 5 includes a must-attend pre-conference session focusing on palliative care, presented by highly sought-after, accomplished names in the field.

See PALLIATIVE p. 3

HCA Memo Details Final State Budget HCA has prepared a memo for members outlining all of the key provisions of the newly enacted state budget.

This memo (available at http://hca-nys.org/wp-content/uploads/2017/04/ 201718FinalStateBudgetMemoFINALVERSION.pdf) adds further flesh to our previous member reports issued in e-mail alerts and in last week’s edition of the Situation Report newsletter. It provides: a summary of the prominent and new home care, MLTC and See BUDGET p. 2

INSIDE Palliative Care Experts Featured at HCA Annual Conference...........................1 HCA Memo Details Final State Budget...........................................................1 MedPAC Confirms Call for New HHPPS by 2021...............................................3 A Message from HCA Sponsor Sandata..........................................................3 Member Hiring Announcement....................................................................4 Court Decision Issued on Live-In Case...........................................................5 Reminder: HCA Sepsis Screening Tool Now Available......................................6 Meet HCA’s Award Winners..........................................................................7

Plan-Provider Partnerships for Five-Star Quality.........................................8 OMIG Issues 2017-2018 Work Plan.............................................................9 New LHCSA Applications Addressed at PHHPC Meeting..............................10 CMS Releases Updated Medicare Home Health HHPPS Booklet.................10 Wound Care Institute Presents Journal Free for HCA Members..................11 NGS Updates.........................................................................................11 Early Intervention FAQs Posted................................................................12 Resources...................................................................................12

The Situation Report: the Home Care Association of New York State

BUDGETfrom p. 1 hospice impacts; the overall health and Medicaid provisions applicable to all providers; a more detailed analysis of highlight provisions affecting HCA members directly; reimbursement actions continued from prioryear budgets; and other health care actions that HCA members need to know about. Please be sure to share this memo with all of your key staff.

With the final budget now passed, the Legislature is adjourned until April 24, when it will resume its 2017 session to deliberate on legislation.

This year’s final budget was unusual for its procedural complexity, including the initial passage of a stop-gap temporary budget extender bill (which is still unsigned) prior to the enactment of a final budget.

The Governor resorted to this short-term extender bill as major issues were still unresolved at the brink of the April 1 fiscal deadline. By excluding many of the larger and budget-wide impact issues, this extender bill provided a means to keep operations running while negotiations continued past April 1. These larger issues were then later incorporated into a final, all-encompassing “revenue bill” once agreements were ultimately reached.

In addition, critical health portions of the budget agreement have been rendered via a “side letter” from the Governor to the Legislature, and not included in the actual budgetary or legislative language, making the review process further unwieldy. The Department of Health, meanwhile, has stated its intent to enact certain provisions administratively, absent underlying budgetary legislative language.

Members with questions about the memo or any specific budget provisions are welcome to contact any of the HCA Policy staff.

Home Care Association of New York State (HCA) 388 Broadway, 4th Floor, Albany, NY 12207 Tele: 518-426-8764; Fax: 518-426-8788; Website www.hcanys.org

2

Volume 2, No. 16 April 17, 2017 

The Situation Report is a weekly publication of the Home Care Association of New York State (HCA). Unless otherwise noted, all articles appearing in The Situation Report are the property of the Home Care Association of New York State. Reuse of any content within this newsletter requires permission from HCA. Joanne Cunningham HCA President jcunningham@hcanys.org Roger L. Noyes Director of Communications, Editor of The Situation Report rnoyes@hcanys.org Al Cardillo Executive V ice President acardillo@hcanys.org Patrick Conole Vice President, Finance & Management pconole@hcanys.org Andrew Koski Vice President, Program, Policy & Services akoski@hcanys.org Alexandra Fitz Blais Director of Public Policy ablais@hcanys.org Laura Constable Senior Director, Membership & Operations lconstable@hcanys.org Celisia Street Director of Education cstreet@hcanys.org Mercedes Teague Finance Manager mteague@hcanys.org Jenny Kerbein Director of Governance & Special Projects jkerbein@hcanys.org Billi Wilson Manager, Meetings & Events bwilson@hcanys.org Teresa Brown Administrative Assistant tbrown@hcanys.org

The Situation Report: the Home Care Association of New York State

Volume 2, No. 16 April 17, 2017 

PALLIATIVE from p. 1 In “Achieving Value through Palliative Care” on May 3, Dr. Todd R. Coté, Program Director for the University of Kentucky’s Fellowship in Hospice and Palliative Medicine, will highlight the status of hospice and palliative care in the current health care landscape.

Dr. Coté is also Chief Medical Officer of Bluegrass Care Navigators (a large, nationally-recognized hospice and palliative care organization). From this vantage point, he will review the value proposition that palliative care continues to offer all of health care while exploring emerging trends in communitybased palliative care.

The palliative care focus will continue during the pre-conference session with palliative medicine and medical marijuana expert Dr. Bernie Lee, Associate Chief Medical Officer of Metropolitan Jewish Hospice and Palliative Care, who will provide an overview of the risks and benefits of the use of marijuana in the palliative care setting. Dr. Lee will highlight the rules and regulations that health care providers should know about New York’s Medical Marijuana Program.

HCA’s Annual Conference is just a few weeks away, so register now to achieve the value of receiving this preconference program AND the main conference program featuring top-notch education sessions and networking opportunities at this biggest, most important HCA event of the year. Register today at www.hcaannualconference.com.

MedPAC Confirms Call for CMS to Implement New Home Health PPS Payment System by 2021 In a meeting this month, the Medicare Payment Advisory Commission (MedPAC) unanimously voted to recommend that the U.S. Centers for Medicare and Medicaid Services (CMS) implement a new home health prospective payment system (PPS) by 2021.

The vote comes a month after the commission – which is tasked with recommending rate adjustments for Medicare’s fee-for-service payment system to Congress – submitted a recommendation in its March Report

3

A message from HCA sponsor Sandata

The Situation Report: the Home Care Association of New York State

Volume 2, No. 16 April 17, 2017 

that CMS impose a 5 percent rate cut to the home health PPS for 2018.

MedPAC states that the new home health PPS would aim to combat payment issues embedded in the current system, including incentives to provide certain types of care for certain patients.

“By rebalancing the financial incentives, the post-acute care (PAC) PPS will correct the current inequities in the Skilled Nursing Facility (SNF) and home health PPS that favor some types of patients and providers over others,” Carol Carter, PhD, principal analyst at MedPAC, said during the meeting.

While MedPAC is an influential voice on payment issues, Congress is not obligated to implement its recommendations, and oftentimes does not.

In January, HCA President Joanne Cunningham sent a letter to MedPAC’s Executive Director, Dr. Mark E. Miller, raising “grave concerns” regarding MedPAC’s home health recommendations for 2018 and the data assumptions underlying them. The letter is at http://hca-nys.org/wp-content/uploads/2017/01/ MedPAC2017ReporttoCongress.pdf.

In the letter, also cc’d to New York’s Members of Congress, Ms. Cunningham presented some New Yorkspecific home health agency financial findings that vary substantially from MedPAC’s aggregate, national data assumptions.

HCA supports a payment system that duly covers home health services and reimburses providers commensurate with the needs of patients. The existing home health PPS has been subject to draconian rate cuts and faulty rebasing initiatives that are largely consistent with MedPAC’s problematic data assumptions and recommendations.

As such, HCA will continue to carefully analyze and weigh in on any further adjustments or Chief Financial Officer overhaul to the existing Oneonta, New York methodology, if Bassett Healthcare Network: At Home Care, Inc. (AHC), a nationally recognized and pursued by CMS, progressive Medicare Certified Home Health Care agency, seeks to hire an executive level financial especially changes that leader. would worsen longtime Operating across five predominantly rural counties in Central NY, AHC is an integral healthcare network payment disparities or partner. With a data driven integrated financial and clinical leadership approach, the individual will be create altogether new responsible for planning, oversight and directing all fiscal operations of the organization. ones.

For further information, contact Patrick Conole at (518) 810-0661 or at pconole@hcanys.org.

4

Candidate Qualifications x Experienced home health financial leader with McKesson Horizon IS experience, preferred x MS Office and accounting software experience required x A clear and concise communicator, written and oral x Education: bachelor’s degree in accounting or finance required; Masters or CPA, preferred Competitive salary and benefit package offered.

For more information, or to submit a CV in confidence, please direct to: Patricia Brown, Director HR; 25 Elm Street, Oneonta NY 13820 Or, E-mail: pbrown@ahcnys.org

The Situation Report: the Home Care Association of New York State

Volume 2, No. 16 April 17, 2017 

Court Decision Issued on Live-In Case This week, the New York State Supreme Court, Appellate Division, First Department, issued a decision in Nina Tokhtaman, etc. v. Human Care, LLC, holding that live-in home care aides are not necessarily a category of employee who need only be paid for 13 hours of a 24-hour shift.

According to the court, live-in aides who fall outside of that category would be entitled to be paid for each hour of a 24-hour shift. It is not clear if this decision will be appealed.

The Court found that a widely cited state Department of Labor (DOL) opinion letter (March 11, 2010) conflicted with DOL regulations [12 NYCRR, section 142-2.1(b)]. Thus the court refused to follow the DOL opinion. The regulations provide that the minimum wage must be paid for each hour an employee is “required to be available for work at a place prescribed by the employer,” except that a “residential employee – one who lives on the premises of the employer” – need not be paid “during his or her normal sleeping hours solely because he is required to be on call” or “at any other time when he or she is free to leave the place of employment.”

The March 11, 2010 state DOL opinion letter advised that all “live-in employees,” regardless of whether or not they are “residential employees,” nevertheless “must be paid not less than for thirteen hours per twenty-four hour period provided that they are afforded at least eight hours for sleep and actually receive five hours of uninterrupted sleep, and that they are afforded three hours for meals.”

The defendants unsuccessfully argued that, based on the state’s opinion letter, a live-in aide need only be paid for 13 hours of a 24-hour shift as long as the aide received the requisite uninterrupted sleep time and meal periods. The court declined to follow the opinion in this case, noting, according to the court, that the opinion “fails to distinguish between ‘residential’ and ‘nonresidential’ employees,” and found that even though the live-in aide admitted to having worked 24 hours a day, seven days a week in the client’s residence, the aide was not necessarily a “residential employee.” Consequently, the court held that if the live-in aide can demonstrate that she was a nonresidential employee, she could recover unpaid wages for hours worked in excess of 13 hours a day.

The standard embodied in the DOL opinion letter, refused by the court, has been relied on by home care providers and the state; thus, if this decision or a similar one is upheld, it will have major ramifications for the delivery of 24-hour/live-in care.

Other cases that include this issue are working their way through the courts, including Andryeyva v. New York Health Care, Inc., on which HCA submitted an amicus brief and on which oral arguments were held in mid-January.

Free member call on court cases On Thursday, April 20, at 10 a.m., HCA will hold a free, members-only conference call to discuss this April 11 court decision that has major ramifications for the delivery of “24-hour live-in” care. To register for this call with legal experts and the HCA Policy team, please complete the online form at the link below and HCA will send you dial-in information in advance of the April 20 call. Register for the call at: https:// www.surveymonkey.com/r/call24hourcases.

Frank Fanshawe, HCA’s counsel and partner at Jackson Lewis, contributed to this article.

5

The Situation Report: the Home Care Association of New York State

Volume 2, No. 16 April 17, 2017 

HCA Home Care Sepsis Screening Tool, Now Available For Use, to Be Featured at National Leaders Forum HCA’s home care sepsis screening tool is being featured next week at the Visiting Nurse Associations of America (VNAA) National Leadership Conference in San Diego. The state Commissioner of Health and others are actively engaging HCA on the merits of this tool as well. HCA applauds members who have been actively signing up, and encourages others to do the same.

While often misunderstood as an “in-hospital” occurrence, the vast majority (over 80%) of sepsis-related infections occur in the home and community. Anyone can develop sepsis from illness or injury. However, the patient population served by home care is among the highest risk for sepsis occurrence.

HCA’s new tool guides home care clinicians on sepsis-risk identification, screening and protocols. In a series of recent webinars, HCA also provided examples of how the tool can be readily integrated into a home care agency’s electronic medical records (EMRs). Participation in these webinars, conducted by HCA and IPRO, is a prerequisite for using the tool.

HCA is offering the tool as a free, direct benefit to HCA Members. HCA will soon make the tool available for non-HCA members at a modest fee.

How to access the tool To access the tool, HCA members must first complete the user agreement, which is required by HCA to help ensure preparation for use, standardization and quality.

The user agreement is available at http://hcaannualconference.com/wp-content/uploads/2017/03/ HCASepsisToolUserAgreement.pdf. By signing it, licensees attest that they have viewed all of the HCA/IPRO instructional webinars for use of the tool, which is a prerequisite. (Users may view archived versions of the webinars to satisfy this requirement. The archived webinars are available at http://atlanticquality.org/ initiatives/sepsis-initiative/educational-eventswebinars/.)

The user agreement also establishes important legal prohibitions on sharing the tool with outside entities.

Licensees also agree to submit de-identified data in connection with using the tool, unless an agency lacks capacity to provide such data. A secure data portal managed by IPRO will be made available for data sharing.

The data sharing will be used by HCA to further support provider use, implementation, effect, evaluation and improvements to the process. It will also assist providers and HCA in promoting the value of this tool both clinically and fiscally. Please see the user agreement for further details on these and other requirements.

HCA, IPRO and partners will conduct initial teleconference meetings (anticipated to be approximately monthly) to review questions, answers and experiences.

To take the next step, please do the following: 

Read the user agreement, assure that your agency meets the requirements, and sign the agreement.



E-mail an attached version of the signed user agreement to sepsistool@hcanys.org.

Continued on next page

6

The Situation Report: the Home Care Association of New York State

Volume 2, No. 16 April 17, 2017 

Continued from previous page 

Upon receipt of the user agreement, HCA will check your membership status, and, once confirmed and accepted, send you the approved user agreement, the tool itself, and further instructions.

If you have any additional questions, please contact sepsistool@hcanys.org.

Meet HCA’s Award Winners, And Cheer them On At HCA’s Annual Conference HCA is proud to announce the winners of our annual awards, which will be presented during a ceremony at HCA’s Annual Conference next month.

HCA’s Awards Committee faced the difficult task of selecting winners from among several exceptional candidates for our Caring; Advocacy; and Ruth F. Wilson award categories.

The finalists are mentioned on the next page, but the summary of their achievements, in this week’s newsletter, only scratch the surface; we strongly encourage all members to attend the award ceremony on May 4 in Saratoga (as well as the entire Mary 3-5 Annual Conference) to hear firsthand the compelling stories behind each award winner’s selection.

Continued on next page

7

The Situation Report: the Home Care Association of New York State

Volume 2, No. 16 April 17, 2017 

Continued from previous page This year’s Caring Award winners are: Amy Bowerman, Director of Patient Services/Director of Quality Home Care Services of the Mohawk Valley Health System, for her dedication to saving patients’ lives through sepsis intervention and commitment to quality enhancement; and Eileen Crawford, Home Health Aide at VNS of Westchester, for her selfless volunteerism and amazing “sixth sense” in spotting patients’ problem health conditions, getting them the right interventions and performing lifesaving CPR for patients during medical emergencies.

Our Advocacy Award recognizes the home care staff at Mid-Hudson Regional Hospital who got their agency through a reorganizational transition following the closure of St. Francis Hospital and Health Centers, garnering a positive state Department of Health survey during the first week in their new network and ardently protecting and supporting their patients throughout. A second Advocacy Award goes to Russell Lusak, Senior Vice President at Selfhelp Community Services, for his leadership positioning home care in the development of health information technology (HIT) policy and his work linking up HIT with value-based payment models addressing social determinants of health, an area of his expertise that he is especially passionate about.

HCA’s Ruth F. Wilson Award, our highest honor, goes to Sara Butterfield, Senior Director at IPRO. For years, Sara Butterfield has been a torch-bearer for the advancement of home care quality, promoting home care’s statewide and national efforts in quality benchmarks, technical assistance and advocacy.

Please join HCA and colleagues in celebrating these exceptional award winners at our Annual Conference.

Details are at www.hcaannualconference.com.

Plan-Provider Partnerships for Five-Star Quality ‘Think Tank’ Session at HCA Annual Conference on May 4, 2017 from 2:15 to 3:15 p.m.

At HCA’s Annual Conference, just a few weeks away, HCA Executive Vice President Al Cardillo, LMSW, will moderate a panel discussion tackling this question: How can managed care plans and providers synchronize their clinical efforts and quality/performance priorities to reach five-star excellence?

Hear from our panel of plan and provider quality leaders as they engage in discussion on the quality indicators that are held in common, exploring the opportunities for garnering five-star outcomes through plan-provider collaboration. Panelists will also highlight any potential system or policy barriers that might inhibit such innovation. They include: 

Amy Bowerman, RN, Director of Quality Improvement/Privacy Officer, Mohawk Valley Health Systems-Home Care Services and Director of Patient Services-Senior Network Health



Sara Butterfield, RN, BSN, CPHQ, CCM, Director, Upstate Health Care Quality Improvement, IPRO



Dianna D’Amico, RN, MA, Director, NY MLTC, Empire BlueCross BlueShield HealthPlus

Take advantage of this panel session and many other exciting programs at HCA’s Annual Conference on May 3-5, 2017, plus attend our Annual Awards luncheon, networking sessions, exhibits, town hall meeting with the HCA Policy team and more. Reserve your seat today at www.hcaannualconference.com.

8

The Situation Report: the Home Care Association of New York State

Volume 2, No. 16 April 17, 2017 

OMIG Issues 2017-2018 Work Plan The state Office of the Medicaid Inspector General (OMIG) announced its new 2017-2018 Work Plan, which details the program integrity areas of focus in the Medicaid program for State Fiscal Year 2017-2018.

This Work Plan applies to providers, suppliers, and managed care organizations, along with other stakeholders. It provides a roadmap for the year focusing on three main goals: 1) enhancing compliance, including provider compliance and monitoring of compliance programs by OMIG; 2) promoting innovative analytics using tools to detect fraud and waste as well as data mining and analysis, cost savings measures, and pre-payment reviews; and 3) “Fighting Fraud, Waste, and Abuse.”

Among its work in all areas of the Medicaid health care system, the Work Plan specifically identifies target initiatives in home health and community-based care services, long-term care services, and Medicaid Managed Care. Specifically, OMIG says it will: 

Continue to work with the visit Verification Organizations (where applicable to certain home care entities) to standardize the reports in the VO portals and to identify areas of potential improvement.



Review and recover billings for claims identified as duplicative.



Continue to audit LTHHCP fee-for-service (FFS) Medicaid claims to verify per-visit and hourly rates calculated for the various ancillary services provided, with a focus on LTHHCPs with both high Medicaid utilization and rate capitations. OMIG will also review rate add-ons, including funds dedicated to worker recruitment, training, and retention.



Continue to conduct personal care and CHHA FFS audits, and will initiate CHHA Episodic Payment System (EPS) audits.



Target compliance pertaining to minimum wage and Wage Parity laws. OMIG says it will “audit managed care organizations and contracted network providers’ records and reports to ensure that funds provided for employee wage increases are properly distributed to health care workers in accordance with statutory requirements and the procedures established by DOH.”



Perform various match-based targeted reviews and other audits in managed care, identified through data mining, analysis, and other sources to recover overpayments and implement corrective actions.

OMIG notes that its executive staff “launched a new project team approach to guide the agency’s program integrity efforts in Medicaid Managed Care. OMIG established a project management office (PMO) with a dedicated project manager and created five teams with specific areas of focus.”



Evaluate Value Based Payment VBP reimbursements from a program integrity perspective, “make recommendations and update audit processes accordingly.”

The full 2017-2018 Work Plan with further details can be viewed at: https://omig.ny.gov/index.php/ information/work-plan.

HCA will seek OMIG’s engagement to further provide details and helpful information to HCA members regarding this plan.

9

The Situation Report: the Home Care Association of New York State

Volume 2, No. 16 April 17, 2017 

New LHCSA Applications Addressed at PHHPC Meeting At the April 6 meeting of the Public Health and Health Planning Council (PHHPC), the PHHPC approved all of the applications related to Licensed Home Care Services Agencies (LHCSAs).

These included: 

Eight entities to establish a LHCSA;



Five entities to establish a LHCSA associated with an Assisted Living Program; and



Seven LHCSAs for a change of ownership.

The applications and background information are at http://www.health.ny.gov/facilities/ public_health_and_health_planning_council/meetings/2017-04-06/.

At the meeting, the state Department of Health (DOH) confirmed that it is now acting on all LHCSA applications; this replaces its past policy of only scheduling LHCSA applications on the PHHPC agenda that requested approval for a change of ownership, were affiliated with an ALP, or were submitted by counties.

HCA reminds members that DOH has recently posted LHCSA guidance materials and procedures for filing policies and procedures manuals at https://health.ny.gov/facilities/home_care/ guidance_docs_for_lhcs_applicants.htm.

CMS Releases Updated Medicare Home Health PPS Booklet The U.S. Centers for Medicare and Medicaid Services (CMS) has recently updated a booklet on the Medicare home health prospective payment system (HHPPS).

The booklet includes the following information: background on HHPPS; consolidated billing requirements; criteria that must be met to qualify for home health services; therapy services; elements of and updates to the HHPPS; physician billing and payment for home health services; and the Home Health Quality Reporting Program.

HCA members can access CMS’s updated HHPPS booklet at: https://www.cms.gov/Outreach-andEducation/Medicare-Learning-Network-MLN/MLNProducts/MLN-Publications-Items/ CMS1243662.html.

For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.

10

The Situation Report: the Home Care Association of New York State

Volume 2, No. 16 April 17, 2017 

Wound Care Education Institute Presents Journal Free for HCA Members HCA has partnered with the Wound Care Education Institute (WCEI) to provide both onsite and online skin and wound care courses at an HCA-member discount for your professional staff.

WCEI is also offering free access for HCA members to see WCEI’s quarterly digital journal, Wound Central, available at https://www.woundcentral.com/. You will need to register as a new user to access the journal.

This issue of the journal focuses on lower extremity wounds. Featured articles include: 

A review of the evidence for adjustable compression wrap devices



Differentiating between red legs and cellulitis



Healing of chronic sickle cell-disease associated foot and ankle wounds using transdermal continuous oxygen therapy

Onsite and Online Wound Care Training for Your Clinicians More information on WCEI’s five-day onsite and online courses is available on a dedicated page of HCA’s website at http://hca-nys.org/hca-and-wcei-partner-on-wound-care-education-courses. These courses offer an evidence-based approach to wound management and current standards of practice, with discounted rates for HCA members. Upcoming onsite courses in New York will take place at the following locations: April 24-28, 2017 Catholic Health Services 144 Genesee St Buffalo, NY 14203 Sept. 11-15, 2017 Marriott East Elmhurst 102-05 Ditmars Blvd.

East Elmhurst, NY 11369

NGS Updates National Government Services (NGS), New York’s Medicare Administrative Contractor (MAC), has recently posted the following information to its website. 

11

Information for Providers who Submit Multiple Faxes in Response to an ADR Request – In an effort to assist providers in avoiding unnecessary denials when responding to a medical review additional documentation request (ADR), NGS states that providers should use a fax cover sheet when submitting multiple documents, noting the total number of pages and an identifier, such as

The Situation Report: the Home Care Association of New York State

Volume 2, No. 16 April 17, 2017 

the DCN, HICN, and/or a copy of the ADR letter. If faxing more than one batch of documents, be sure to include that on the cover sheet, (i.e., batch 1 of 3, batch 2 of 3, etc.).

If the fax submission is not working, please choose an alternative method of delivery, (i.e., USPS, CD, esMD, NGSConnex). Additional information is available on NGS’s website under the Medical Policy and Review tab/Medical Review. 

Reminder: Only Zero Charges Allowed on Revenue Line 0023 – NGS says it has received many claims recently billed with charges other than zero on the 0023 revenue line. Yet, both requests for anticipated payments (RAPs) and episode final claims must be billed with zero charges on revenue line 0023. Any charges other than zero cause claims processing errors and are out of compliance with home health billing guidelines.

The U.S. Centers for Medicare and Medicaid Services (CMS) Claims Processing Manual (https:// www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c04.pdf) states that total charges are required for this revenue line and “The HHA reports zero charges on the 0023 revenue code line.”

For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.

Early Intervention FAQs Posted The state Department of Health (DOH) has posted Frequently Asked Questions (FAQs) on the Early Intervention (EI) program.

The FAQs are on the Health Commerce System (https://commerce.health.state.ny.us/public/ hcs_logout.html) and also at http://hca-nys.org/wp-content/uploads/2017/04/Early-Intervention-FAQs_April-2017.pdf.

The FAQs cover: contents of a session note; record retention requirements; use of electronic records; changes in eligibility; transfer of cases; use of ICD-10 codes; provider continuing education requirements; components of a quality assurance plan; and others.

Resources 

“Medicare Provider Education: Oversight of Efforts to Reduce Improper Billing Needs Improvement,” by the U.S. Government Accountability Office http://www.gao.gov/assets/690/683312.pdf



“Health Care: Telehealth and Remote Patient Monitoring Use in Medicare and Selected Federal Programs,” by the U.S. Government Accountability Office http://www.gao.gov/products/GAO-17-365

For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.

12