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Hospice/Home Health

News
Modified: 4/9/2024
In November 2018, the CMS finalized a new case-mix classification model, the 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.
Providers billing Medicare should determine if a patient is enrolled in hospice before billing Medicare Part A. This article has tips on checking patient eligibility and avoiding hospice claim rejects.
More
list item View CMS Newsroom Center external link (Spotlights, news, media releases, outreach, mailing lists, etc.)
Medical documentation
Medical record documentation is used to verify that services were billed correctly and to ensure that payment and processing of Medicare claim(s) are accurate and based on sound policy. Find information, tips, and resources regarding medical documentation.
More
Audit and compliance
list item CERT resources
list item OIG report A-09-18-03031 external link -- CMS could have saved $192 million by targeting home health claims for review with visits slightly above the threshold that triggers a higher Medicare payment
Education
Utilize educational information from First Coast and CMS on hospice/home health services.
list item Visit On-Demand Learning – access First Coast’s webcast recordings, web-based training, videos and tutorials
Additional educational opportunities
list item Home health referrals and clinical documentation requirements compressed file – An A/B and HHH MAC Collaboration Event
list item View Palmetto GBA upcoming events external link -- Florida hospice/home health contractor
list item View NGS upcoming events external link -- Puerto Rico and U.S. Virgin Islands hospice/home health contractor
CMS educational opportunities
list item Search for CMS upcoming events external link
list item CMS open door forums -- overview external link
CMS Internet-only manual (IOM)
The CMS’ IOMs contain day-to-day operating instructions, policies, and procedures based on statutes, regulations, guidelines, models, and directives. The following CMS IOM contains information specific to hospice and home health providers:
Resources
list item Visit the Hospice Center external link on the CMS website.
View additional resources identified specifically for hospice and home health services.
CMS and contractor resources
Professional associations
General resources
More
Claims data
Denials, RTPs and Rejects
list item Resources/tips to avoid or correct reject reason code C7010
list item Resources/tips to avoid or correct hospice overlapping an inpatient stay
list item Avoid hospice rejects with these helpful tips
Stay informed
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First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.
Part A