A message from HHS Secretary Kathleen Sebelius on National Men’s Health Week and Father’s Day:
A father’s love and full involvement in his children’s lives is crucial to their health, well-being, and development.
Fathers influence the physical well-being of their children in a number of ways -- by being engaged in their lives, supporting a mother’s health, or by ensuring that children get the preventive services, such as vaccinations and well-baby checkups, they need to stay healthy. Fathers make a difference.
Studies have shown a father’s own health makes a difference to their children’s health. Active toddlers, for example, are more likely to have fathers with a lower Body Mass Index than less active children.
National Men’s Health Week, June 10-16, which concludes with Father’s Day, is a good time to focus on how men can take care of their own physical and mental health for themselves and for the well-being of their families. That means eating right, being active, and getting health insurance to ensure their families’ security and peace of mind.
Quality health insurance, however, has not always been easily accessible or affordable for millions of Americans who don’t get insurance through their jobs. Millions of men are uninsured. An accident or illness could lead to crushing debt devastating to their families’ security.
But thanks to the Affordable Care Act, new options will soon be available for the nearly 23 million men who are eligible. Beginning October 1, 2013, individuals and small businesses will be able to visit a Health Insurance Marketplace to compare health coverage options and choose the plan that best fits their needs and wallet. In fact, some individuals will be eligible for free or low-cost plans. Coverage will begin as early as January 1, 2014.
Because of the health care law, starting January 1, no one can be turned away or charged more for coverage (whether through the Marketplace or otherwise) because of a pre-existing condition, such as heart disease, diabetes, or prostate cancer. The Affordable Care Act also requires most private health insurance plans to cover recommended preventive services, such as cholesterol checks, alcohol misuse counseling, depression screening, and help to quit smoking.
At the Department of Health and Human Services, we’re also helping fathers develop responsible parenting skills and economic stability. Head Start and Early Head Start programs are bolstering resources and training for creating father-friendly programs to make it easier for men to engage in their children’s lives.
The Administration for Families and Children works in partnership with the National Responsible Fatherhood Clearinghouse to support Fatherhood Buzz, an initiative to promote responsible fatherhood and provide community resources through barbershops across the country. The Clearinghouse recently unveiled new public service announcements, featuring the characters from the movie Despicable Me 2 and focusing on the theme “Take Time to be a Dad Today.”
These programs aim to connect dads to jobs, training, and other resources. They also strengthen the bonds between couples with children, reduce domestic violence, and help provide children strong role models of adulthood.
To my Dad and all the dads out there -- and all the family and community members working to help them succeed as parents -- thank you for helping our children thrive, and for helping to ensure a brighter future for us all. Please take care of yourselves for us.
Happy Father’s Day!
Develop a financial & operational roadmap to transition with ease
ICD-10 demands preparation, or else your home health agency will see rejected claims, payment delays, and even fines. Save time and money by attending the only ICD-10 implementation training specifically designed with the budgets, resources and needs of independent home health agencies and hospices in mind.
We’ll cover how ICD-10 will affect every aspect of your business and help you structure the transition plan appropriate for your agency.
Join DecisionHealth, NAHC, CMS and major home health software vendors for:
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Payment implications of case mix diagnoses like diabetes, hypertension, congestive heart failure affected by ICD-10 documentation changes
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Budgeting for the ICD-10 transition and how to reasonably calculate the dollars you'll need
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Workflow and form changes, including how OASIS and plan of care documentation must be changed; you’ll also take home ICD-10-CM-ready sample forms and templates
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Needed software system upgrades and why you can’t leave it to your vendors, including a case study with one independent agency that's successfully made major changes
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Coding department workflow re-engineering and skill improvements, including whether outsourcing makes sense given your patient mix, existing staff productivity and caseload
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Hidden operational impacts you need to plan for, such as changes to intake processes, clinical encounters, accounts receivable, and more
Register today to ensure that your operations, staff and procedures are ready for the Oct. 1, 2014 deadline.
From the Decision Health article
Is forming or joining an Accountable Care Organization (ACO) part of your homecare business objectives for 2014? If so, today is your last day to take advantage of incentive payments under Medicare’s Shared Savings Program.
- Submit a Notice of Intent to Apply - May 1 through 31, 2013 for Program Year 2014
Each ACO must submit a short Notice of Intent to Apply (NOI) through the
Web form. CMS must receive your completed NOI no later than 5 p.m. EST May 31, 2013.
2. Get a CMS User ID to Submit Your Application - (Complete after you submit an NOI, DUE June 10, 2013)
To submit your application, you need a CMS User ID to access the Health Plan Management System (HPMS.) Submit Form CMS-20037 Application for Access to CMS Computer Systems by
using the link and instructions provided in your NOI acknowledgement Email, via tracked mail (Federal Express, United Parcel Service, etc.) and; no later than June 6, 2013. Do not wait until the deadline.
3. Complete Your Application
You must submit your application online through HPMS. The information posted below is for reference only.CMS will accept applications from July 1 through July 31, 2013.
Application
Forms (2013 Forms are available for reference. The 2014 Forms are coming soon)
Who to Contact for Assistance
Today, there are 259 Accountable Care Organizations (ACOs) that represent 8 percent of the Medicare population. Nearly half are physician-led according to The Advisory Board Company and at least one ACO exists in every state. As many as 4 million beneficiaries are now covered by an ACO – with more growth expected by the end of 2013.
With this in mind and as the Affordable Care Act is in implementation mode, how you manage your homecare business will need to change. Moving to a new reimbursement model based upon outcomes, not services rendered, the accountable care model now aligns incentives in a patient-focused way. Homecare businesses needed to focus on building their value on coordinating flawless care transitions, how in-home care prevents hospital readmission and hospital-at-home programs.
There are many home care agencies that are partnering with major insurers and hospital systems to set up care transition programs that include both clinical and non-clinical services. An important of your homecare business is to increase your referrals, deliver good patient care, and keep patients at home at a lower cost. If you join an ACO, do those same goals align with your business objectives? This is one question to consider as you investigate joining an ACO in your community.
As managing population health, moving to automated clinical and financial management is essential to your business health. You have in hand huge amounts of patient data – both clinical and financial – a powerful analytics tools are needed to manage that data into actionable and meaningful items.
These are your business challenges: making good use of your data to help you increase referrals, potentially join an ACO, and help patients recover from hospital stays with good outcomes and satisfaction. Lastly, after all these objectives are met or exceeded, this will enable you to quantify and demonstrates your value to partners and potential partners.
Home care software for scheduling, billing and point of care automation can assist your home care business in moving forward with the business model changes by facilitating improved care quality and true agency automation.
CMS and contractor National Government Services (NGS) have updated end-to-end testing checklists to incorporate comments from providers, payers, and vendors. The checklists were developed and refined as part of an end-to-end testing project that uses ICD-10 as a business case. The project goal is to develop an industry-wide “best practice” for end-to-end testing that lays the groundwork for a more efficient and faster method for health care provider testing of future standards. More efficient testing will enable providers to adopt future standards more rapidly.
Additionally, the goals of the pilot are:
- To develop and implement a process and methodology for End-To-End testing of the transaction standards, operating rules, code sets, identifiers, and other Administrative Simplification requirements adopted by the Secretary of Health and Human Services (HHS) under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Patient Protection and Affordable Care Act of 2010 (ACA) based on industry feedback and participation.
- To develop an industry wide “Best Practice” for End-to-End Testing that lays the ground work for a more efficient and less time consuming method for health care provider testing of future standards, leading to more rapid adoption of the future standards.
The pilot is in a phased approach:
- Phase I – Business and Gap Analysis started on September 24, 2012 and will run through December 21, 2012 (Completed)
- Phase II - Development of Pilot Testing started on December 10, 2012 and will run through June 27, 2013 (approximately six months)*
- The planned start date for Phase III - Implementation and Quality Assurance is July 1, 2013, and will run through September 23, 2013 (approximately three months)*
*Actual dates are subject to change during detailed schedule development
The updated checklists are available on the CMS Administrative Simplification end-to-end testing page.
Keep Up to Date on ICD-10 and Visit the CMS ICD-10 website for the latest news and resources and the ICD-10 continuing medical education modules developed by CMS in partnership with Medscape to help you prepare for the October 1, 2014, deadline.
The Centers for Medicare & Medicaid Services has released change request 8244 that provides instructions for home health agencies to discontinue the use of Type of Bill (TOB) 033x and redefines TOB 032x to mean “Home Health Services under a Plan of Treatment.”
Currently, home health agencies use either bill type 032x or 033x on their claims for home health service provided under a home health plan of treatment.
TOB 032X and TOB 033x are defined as follows:
- 32x - Home Health – Inpatient (plan of treatment under Part B only)
- 33x – Home Health – Outpatient (plan of treatment under Part A, including DME under Part A)
Depending on the circumstances, Medicare home health services are paid either under Medicare Part A or Part B. For example, if the patient is enrolled in both Part A and Part B and does not met the coverage criteria under Part A, the services will be financed under Part B of the program. Conversely, if the patient is only enrolled in Part A or Part B, the home health services will be financed under the part of the program that the beneficiary is enrolled. The portion of the Medicare program that finances home health services is determined at the claims processing system level.
If an agency places the wrong TOB on the claim, the system automatically makes a correction to ensure the appropriate portion of the Medicare Trust Fund is financing the services.
In 2012, the National Uniform Billing Committee - which maintains the TOB code set healthcare organizations use on claims - voted to simplify the TOB codes used for home health claims when services are provided under a home health plan of treatment. The choice was to eliminate TOB code 033x and redefine TOB code 032x to be used on all claims for home health services under a plan of treatment. Agencies will continue to submit claims with TOB 034X to bill for services when there is no home health plan of treatment.
All home health request for anticipated payments (RAPs) and claims with a “From” date on or after October 1, 2013, with a TOB 033x will be returned to the provider for correction.
To view the Change Request click here
From the NAHC Report Article
HHS Secretary Kathleen Sebelius today announced that more than half of all doctors and other eligible providers have received Medicare or Medicaid incentive payments for adopting or meaningfully using electronic health records (EHRs).
HHS has met and exceeded its goal for 50 percent of doctor offices and 80 percent of eligible hospitals to have EHRs by the end of 2013.
Since the Obama administration started encouraging providers to adopt electronic health records, usage has increased dramatically. According to the Centers for Disease Control and Prevention (CDC) survey in 2012, the percent of physicians using an advanced EHR system was just 17 percent in 2008. Today, more than 50 percent of eligible professionals (mostly physicians) have demonstrated meaningful use and received an incentive payment. For hospitals, just nine percent had adopted EHRs in 2008, but today, more than 80 percent have demonstrated meaningful use of EHRs.
“We have reached a tipping point in adoption of electronic health records,” said Secretary Sebelius. “More than half of eligible professionals and 80 percent of eligible hospitals have adopted these systems, which are critical to modernizing our health care system. Health IT helps providers better coordinate care, which can improve patients’ health and save money at the same time.”
The Obama administration has encouraged the adoption of health IT starting with the passage of the Recovery Act in 2009 because it is an integral element of health care quality and efficiency improvements. Doctors, hospitals, and other eligible providers that adopt and meaningfully use certified electronic health records receive incentive payments through the Medicare and Medicaid EHR Incentive Programs. Part of the Recovery Act, these programs began in 2011 and are administered by the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator of Health Information Technology (ONC).
Adoption of EHRs is also critical to the broader health care improvement efforts that have started as a result of the Affordable Care Act. These efforts – improving care coordination, reducing duplicative tests and procedures, and rewarding hospitals for keeping patients healthier – all made possible by widespread use of EHRs. Health IT systems give doctors, hospitals, and other providers the ability to better coordinate care and reduce errors and readmissions that can cost more money and leave patients less healthy. In turn, efforts to improve care coordination and efficiency create further incentive for providers to adopt health IT.
As of the end of April 2013:
- More than 291,000 eligible professionals and over 3,800 eligible hospitals have received incentive payments from the Medicare and Medicaid EHR Incentive Programs.
- Approximately 80 percent of all eligible hospitals and critical access hospitals in the U.S. have received an incentive payment for adopting, implementing, upgrading, or meaningfully using an EHR.
- More than half of physicians and other eligible professionals in the U.S. have received an incentive payment for adopting, implementing, upgrading, or meaningfully using an EHR.
For more information about the Administration’s efforts to promote implementation, adoption and meaningful use of EHRs and health IT systems, please visit: http://www.cms.gov/EHRIncentivePrograms and http://www.healthit.gov.
From the U.S. Department of Health Press Release
NAHC President Val J. Halamandaris recently issued a detailed statement praising the work of the Medicare Fraud Strike Task Force, known as HEAT, while also reiterating that home care fraud is committed by a relatively small number of individuals.
Below is the statement in its entirety:
“NAHC commends the Medicare Fraud Strike Task Force and law enforcement agencies for taking action this week to stem what appears to be a coordinated Medicare fraud scheme to divert federal money intended for care of the aged and infirm by charging 89 people in eight cities and totaling approximately $223 million in alleged false billing. While we support aggressive enforcement the accused are innocent until proven guilty.
NAHC has always had a zero-tolerance policy for those who would look to divert funds from Medicare and Medicaid for their own personal gain. We have taken a very focused and aggressive approach to fraud and abuse concerns in home health care. NAHC believes that patients and providers alike have the duty to help maintain the fiscal integrity of government programs. Additionally, we believe we should not discourage the thousands who are struggling to do a great job in caring for the ill, infirm and people with disabilities, and who will need to provide home-care services to the large percentage of the 78 million baby boomers.
The health care reform law includes numerous provisions that NAHC initiated to help stop high risk parties from entering Medicare in the first place as well as to catch them as quickly as possible when they fail to properly safeguard Medicare. These include stricter provider participation screenings, the authority for a moratorium on new providers, and the highly successful limit on outlier billings that eliminated a systemic abuse by certain home health businesses. We believe it is imperative that home health agencies faithfully execute physician orders calling for the extension of in-home medical care while following the highest standards of care.
NAHC is continuing its efforts to strengthen program integrity measures in Medicare and Medicaid by offering recommendations to further reduce wasteful spending and prevent fraudulent conduct. These recommendations include home health management credentialing, a requirement that all home health agencies have a corporate compliance plan and strengthen admission standards for new Medicare home health agencies.
The fraud committed by the very few, hurts all of home care and the patients we serve. The industry must be a leader in in health care compliance and program integrity. NAHC has made great progress in that regard and will continue to set the gold standard for all of health care.”
NAHC’s Legislative Blueprint similary addresses fraud and abuse in several different sections.
To review the full Legislative Blueprint, please click here.
From the NAHC Report article
How is your homecare agency preparing for ICD-10?
This may go down as the understatement of the year, but it’s official: Home health agencies are far behind the timeline suggested by CMS and consultants for ICD-10 implementation.
Home health agencies seem confused about how to prepare financially and lack urgency, despite a rapidly dwindling calendar, according to a major nationwide survey conducted by DecisionHealth and the
National Association of Home Care & Hospice.
Survey respondents, which were all home health agencies, appear to “underestimate both the scope of the transition and the severity of the impact to cash flow in 2014,” the study’s authors observed.
Key findings include:
- 90% of respondents have not completed an ICD-10 gap analysis
- 75% have no implementation plan yet and 10% will not develop a plan until Q2 2014
- Nearly 63% said that ICD-10 was not a high priority because of other, more pressing challenges
- A majority of respondents do not plan to begin training their clinical and support staff until 2014
- 25% do not plan to begin training their coders until 2014
- 83% of respondents believe they will be ready in 2014
The last bullet point suggests that many agencies may be overly confident and don’t fully understand what’s needed to actually be ready, the study’s authors write. The full results will be presented at the
ICD-10 Implementation Strategies for Home Health conference, June 6-7, in Chicago.
Attendees who
register for this conference will immediately receive a 21-page PDF copy of the study, including charts, analysis, and the complete findings. Those interested in the conference may
register now and use the code C1377WP to receive a copy of the
National Home Health ICD-10 Readiness Study.
Conference details: The
ICD-10 Implementation Strategies for Home Health conference is the only training event designed with the needs and resources of home health agencies in mind. It will help agency executives and administrators develop a financial and operational road map for ICD-10 to ease the transition and avoid penalties. Detailed sessions on operational best practices will ensure attendees leave with cash flow backup plans, a transition plan, and detailed tactics to adapt daily workflow to a post-ICD-10 world.
Starting with Mother’s Day, next week we celebrate National Women’s Health Week. As a nation, we honor the women in our lives – our mothers, grandmothers, aunts, sisters, cousins, friends, and colleagues – by encouraging them to make their health a priority and to take steps to live healthier, happier lives.
Women are frequently the health care decision-makers in their families. We take time off from work to drive a parent to the doctor. We hold our children’s hands while they get their vaccinations. We make the appointments for our spouses’ checkups – and then make sure they actually go. We stretch and re-work our family budgets to pay the doctor’s bills. And too often, we put our own health last.
But the truth is unless we take care of ourselves first, we cannot really take care of our families. That means we have to eat right, exercise, and get the care we need to stay healthy. Unfortunately, preventive care has not always been easily accessible or affordable for everyone, including young women.
But the health care law is helping to usher in a new day for women’s health. The Affordable Care Act is making it easier for women to take control of their own health. For many women, preventive services like mammograms, Pap smears, birth control, and yearly well-woman visits are now available without cost sharing. The health care law improves women’s access to appropriate preventive health screenings, which can help detect diseases early, when treatment is most effective and least costly.
Starting next year, insurance companies will no longer be allowed to refuse us coverage just because we’re battling breast cancer or have another pre-existing condition – and they won’t be allowed to charge us more just because we are women.
If you’re one of the millions of women who are uninsured or who buy insurance on their own, more options are on the way because of the Affordable Care Act. Starting October 1, 2013, you will be able to visit a new Health Insurance Marketplace where you can compare and choose from a range of plans to find one that best fits your needs and budget. All of these plans must cover a package of essential health benefits, including maternity and newborn care.
To get more information about the Marketplace and to sign up for email and text updates to get ready for October, visit HealthCare.gov.
Being healthy starts with each of us taking control. So Monday on National Women’s Checkup Day, and during National Women’s Health Week, I encourage you to sit down with your doctor or health care provider and talk about what you can do to take control of your health.
There’s no better gift you can give yourself – or your loved ones.
Article is from the National Women’s Health Week Statement from Secretary Sebelius