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What to Watch for on the Hospice Regulatory Landscape in 2018

What to Watch on the Hospice Regulatory Landscape in 2018

2017 was marked by more than a new president and administration in the nation’s capital. The year also brought forth a number of new regulations impacting post-acute care and hospice providers. With the start of 2018, hospice providers are ramping up to deal with new regulations coming into effect and working out the kinks on requirements that recently were implemented in 2017. Here are some regulations hospice providers should be watching in 2018:

With 2017 in the rear-view mirror, home health care providers are looking forward at what is coming down the road in the new year ahead. Here are a few regulatory issues agencies should keep their eyes on as 2018 unfolds:

Targeted probe and educate

The Centers for Medicare & Medicaid Services (CMS) expanded its targeted probe and educate (TPE) program on October 1, 2017, to include hospice providers. Unlike other audit processes, TPE only targets providers with high improper payment rates, data analysis or billing patterns.

Providers that are subject to TPE will be selected by their Medicare Administrative Contractor (MAC) and asked to submit between 20 and 40 claims for review. If these claims are found to have errors or improper billing and payments, the provider will have the opportunity to correct those issues with the next round of new claims selected for targeted probe and review. Each round of review is called a probe, and providers can be probed up to three times before CMS may take other action, including the potential for 100% prepay review.

The process allows providers to receive one-on-one education with their MACs to understand what may be causing high error rates in claims. For providers with low rates of improper payments, the risks are low, and providers that are selected for TPE have opportunities to make corrections for new claims targeted in future rounds.

“MACs also educate providers throughout the probe review process, when easily resolved errors are identified, helping the provider to avoid additional similar errors later in the process,” according to CMS.

Medicare beneficiary ID

Beginning April 1, 2018, all new and existing Medicare beneficiaries will start to receive new Medicare Beneficiary Identifiers (MBI), which replace old Medicare cards. All new Medicare beneficiaries will only receive cards with the new MBIs. The change is meant to help fight medical identity theft for people with Medicare, as the old cards used to display Social Security Numbers (SSNs), CMS stated. The move was announced May 30, 2017, and replaces the Health Insurance Claim Number (HICN) that current Medicare beneficiaries use.

Hospice providers can help ensure all patients are utilizing these new Medicare numbers to ensure proper billing. Once the changeover process begins, providers have a transition period that runs through December 31, 2019. After, Jan. 1, 2020, providers will need to use MBIs on claims with a few exceptions, according to CMS. Providers and hospice staff should be prepared to ask patients for their new cards at the start of care. The new numbers are assigned at random and contain 11 digits, including letters and numbers. Hospices should also be ready to use the new MBIs in their current software systems, including clinical documentation and patient eligibility verification.

Hospice Compare

CMS launched Hospice Compare in August 2017, enabling consumers to search and view hospice providers. Eventually, Hospice Compare will display data from both CMS’ Hospice Item Set (HIS) and Hospice Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey. Beginning February 2018, Hospice Compare will report CAHPS measures for the first time. On Dec. 1, 2017, CMS released provider preview reports for the first hospice CAHPS public reporting with a 30-day preview period to give providers the opportunity to see the survey results prior to public display on Hospice Compare.

Since the website became available, it has experienced a few hiccups and updates. On Nov. 28, 2017, CMS alerted the hospice industry that the search function on the website was not operating correctly.

“CMS is aware that the location search on Hospice Compare may return incorrect results,” CMS said at the time. “As a result, we have provided a message on the home page of Hospice Compare informing users that when searching by location, the list of agencies provided may not serve the zip code, city or state they entered.”

Earlier in the month, a refresh of the data set was delayed. In January 2018, CMS issued a new data guidance and stated it was working with providers to ensure they submit accurate data. Hospice providers should continue to monitor updates from CMS on Hospice Compare changes, particularly as changes emerge and new guidance is released.

Hospice NOEs

Beginning Jan. 1, 2018, hospice providers will be able to submit Notices of Election (NOEs) electronically. Providers must submit NOEs within five days of admission for Medicare to cover the patient. While the paper-based submissions for NOEs proved to be problematic, providers should keep a few things in mind on electronic submission methods.

Namely, the electronic submissions do not change the processing edits and/or payment policies in NOE transactions, and the same five-day window remains. Furthermore, while providers will be able to submit NOEs more quickly, the time it could take to be accepted won’t necessarily be faster. Hospices also need to be wary that MACs will perform an upfront edit on NOE data and return the results within a 277-claim acknowledgement file, but the acceptance of the file does not necessarily mean the NOE transactions won’t be returned to the provider. The NOE transactions could still fail to pass Medicare back-end Common Working File edits, so hospices should maintain a process that checks direct data entry (DDE) for the final status of electronic NOE transactions.

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