IAHHC Hospice Newsletter

Transcription

1 IAHHC Hospice Newsletter Vol. 2, Issue 2 February 2011 A Publication of the Indiana Association for Home & Hospice Care, Inc. Accessing the Redesigned PS&R: Tips for Registration in the IACS Security System The Provider Statistical & Reimbursement (PS&R) system, which accumulates statistical and payment data for Medicare providers including home health agencies and hospices has been redesigned, and PS&R reports are now available on the Centers for Medicare & Medicaid Services (CMS) website. Fiscal Intermediaries/Medicare Administrative Contractors (FIs/MACs) will no longer issue PS&R summary reports used in filing for cost reporting periods, as had been the case in prior years. Providers must register to access the redesigned PS&R system and receive their PS&R reports for filing the Medicare cost report (HHFMA Update, 10/9/09). CMS explained this in Change Request To begin the process to access the redesigned PS&R system, providers must register in Individuals Authorized Access to the CMS Computer Services (IACS), the CMS security system. The first step is to designate a Security Official for your organization. The Security Official will not have access to the PS&R system, but rather will approve the organization s Backup Security Official and all users of the system; the Security Official is the gatekeeper to the PS&R system for the provider. This registration process can take up to three to six weeks, since the Security Official must mail supporting documentation to IACS to confirm that the organization is an approved Medicare provider. It is highly recommended to have a Backup Security Official in the event the Security Official is unavailable or no longer is employed by the provider. The Backup Security Official is optional, however. A provider can also have End Users, which function just as a User Group Administrator does (the User Group Administrator is required, but End Users are optional). Having End Users in place also is highly recommended so that in the event the User Group Administrator is absent, someone can still access the PS&R system. To begin the process to access the redesigned PS&R system, providers must register in IACS (Individuals Authorized Access to the CMS Computer Services), the CMS security system. The following are links to detailed quick reference guides to assist these various positions in registering in IACS: Security Official (required) User Group Administrator (required) Backup Security Official (optional but recommended) End User (optional but recommended) The Security Official must be completely registered before the User Group Administrator and End User can sign up. Once the Security Official completes the online registration, he/she should receive the following regarding what information must be mailed to IACS (this message should come within one to two days after registration, so if it is not received in that time frame, check your junk/spam mail folder or check with your IT department). Please see sample on page 2. The Security Official must submit the data to complete the approval process. Once the final approval is com-

2 Hospice Newsletter February 2011 Page 2 pleted for the Security Official, the User Group Administrator should then follow the instructions specific to his/her role for registering in IACS. When the User Group Administrator has completed his/ her registration profile, the Security Official will be notified via of a pending request to approve. The Security Official then logs in to IACS and approves the User Group Administrator request. Approval will be effective immediately, and the User Group Administrator then will be able to access PS&R reports. Once the User Group Administrator is approved, the provider then has the option to designate End Users. End Users must be approved by the User Group Administrator. Again, it is recommended that providers also have in place a Backup Security Official, which must be approved by the Security Official. The User Group Administrator may be approved either by a Security Official or Backup Security Official. Sample This is in reference to your submitted IACS request with the following Request Number: XXXXXXXXXXXXX In order to process your submitted IACS request, a copy of your organization s CP575 form from the Internal Revenue Services (IRS) is required. The CP575 is the letter sent by the IRS when a Tax Identification Number is issued. If you cannot locate your CP575, contact the IRS for a copy of your IRS Federal Tax Deposit Coupon, IRS 147C letter, or other official IRS document which verifies the taxpayer identification number and legal business name of your organization. The phone number is Mail a copy of the IRS CP575 (or appropriate substitute) to CMS External User Services (EUS), which will be facilitating the registration process. Be sure to write your IACS Request Number near the top of the IRS Document you are sending. EUS can be contacted at the following address and telephone number: External User Services P.O. Box San Antonio, TX Phone: TYY: EUSSupport@cgi.com In some instances, several important steps have been missed when registering in IACS, including: When the Security Official registers, he or she must enter the CMS Certification Number (CCN), which is the six-digit Medicare provider number filed on the Medicare cost report. Once a User Group Administrator or End User completes IACS registration, he or she must then complete the PS&R application in order to access the PS&R system. To do this, follow these steps: 1. Go to the CMS Application Portal website at 2. Read the information on the page and then select Enter CMS Applications Portal. 3. Select Account Management in the menu bar at the top of the page. 4. Select My Profile. 5. Enter your IACS user ID and password. 6. Select Modify Account Profile. 7. Select Access Request from the Select Action drop-down menu. 8. Select Add Application. 9. Select PS&R. Additional Helpful Links for the Redesigned PS&R Registration is done at For problems/ issues with registration, contact the IACS Help Desk at or EUSSupport@cgi.com. Once registered, PS&R reports are available by logging into the PS&R website at For more information, visit CMS PS&R website at It is recommended that providers also have in place a Backup Security Official, which must be approved by the Security Official. The User Group Administrator may be approved either by a Security Official or Backup Security Official.

3 Page 3 Hospice Newsletter February 2011 The Only Constant is Change Proposed MedPAC Recommendations Recently, MedPAC released their proposed recommendations to CMS. Below is a summary of that report that IAHHC distributed when the report was released. IAHHC Summary of MedPac Recommendations for March 2011 Report to Congress The MedPac met on January 14, 2011 and discussed hospice. It is expected that the following recommendations will be made in MedPac s report to Congress in March. Hospices should begin serious consideration of how they would be impacted by these recommendations. 1. 1% update in the hospice payment rates for the 2012 fiscal year. Commissioners also voted to reprint the payment reform recommendation to: Increase payments per day at the beginning of the episode and reduce payments per day as the length of the episode increases. Provide an additional end-of-episode payment to reflect hospices higher level of effort at the end of life. 2. Budget neutral payment change that would redistribute revenues Overall, revenues would increase for provider-based, non-profit, and rural hospices and decrease for other provider types. 3. The Secretary (of HHS) should direct the Office of Inspector General to investigate: The prevalence of financial relationships between hospices and long-term care facilities such as nursing facilities and assisted living facilities that may represent a conflict of interest and influence admissions to hospices. Differences in patterns of nursing home referrals to hospice. The appropriateness of enrollment practices for hospices with unusual utilization patterns (e.g. high frequency of very long stays, very short stays, or enrollment of patients discharged from other hospices). The appropriateness of hospice marketing materials and other admissions practices and potential correlations between length of stay and deficiencies in marketing or admissions practices. The guiding principle MedPAC used throughout its discussions of recommendations this year has been to propose elimination of annual updates to provider payment rates in most cases where healthy financial margins are present (and in some cases, to recommend acceleration of planned payment reductions). The guiding principle MedPAC used throughout its discussions of recommendations this year has been to propose elimination of annual updates to provider payment rates in most cases where healthy financial margins are present (and, in some cases, to recommend acceleration of planned payment reductions). MedPAC projects that hospice Medicare financial margins will be 4.2 percent for 2011, down from 5.1 percent in The projections include consideration of the 2011 further phase-out of the BNAF, annual changes in the wage index, and costs of the face-to-face encounter requirement. However, the 4.2 percent projected average margin for 2011 does not include the impact of the FY 2012 portion of the BNAF phase-out, which would further reduce average margins by 0.6 percent. The following issues were discussed at the meeting and are expected to be further discussed/investigated. Hospices should thoughtfully consider these topics: The potential for the use of hospice to reduce overall Medicare spending for beneficiaries nearing the end of life. Concerns about inappropriate or too-early referrals to hospice. Concerns about whether Alzheimer s patients are appropriate for hospice. Concerns about volunteer and bereavement services and how they should be treated in the computation of margins. The failure of the Medicare program to provide sufficient counseling and guidance to Medicare beneficiaries regarding hospice as an option for care. The lack of quality data for hospices. The advisability of Medicare offering curative care concurrent with hospice services. The experience of Medicare Advantage organizations, accountable care organizations, and others relative to hospice treatment. Potential beneficiary copayments as a means to reduce inappropriate hospice utilization. The data and information slides used to guide MedPAC s hospice discussions are available at transcripts/hospice_january2011%20for%20public.pdf. A transcript of the discussions is usually posted online at the MedPAC website at within a week of the scheduled meeting. Sources: National Association for Home Care and Hospice, NAHC Report, 01/18/2011 National Hospice and Palliative Care Organization, News Alert, 01/14/2011 MedPac, Assessing Payment Adequacy: Hospice, 01/14/2011

4 Hospice Newsletter February 2011 Page 4 Staying the Course We cannot escape the numerous regulatory changes which have and will continue to impact hospice operations and financial status. This is a significant period of transition for hospices that we ve not seen in the recent past. We have increased scrutiny of billing and clinical practices and clinical outcomes of care as well as reduced funding amidst increased compliance requirements. A number of providers have inquired about what can be done now to remain in good standing with regulatory requirements and to prepare for continued healthcare reform while keeping the financial figures out of the red zone. There is much work ahead of us, and we can be best prepared by knowing our organizations very, very well. Hospices, like all other health care providers, will continue to be required to respond quickly and adapt to new regulatory requirements without getting distracted from providing quality care. In fact, we ll be required to adapt to regulatory changes while at the same time improving patient care outcomes and measuring those outcomes. Hospices will be able to quickly adapt by having a thorough, in-depth knowledge and understanding of their hospice program and how all the components of their programs are intertwined and impact each other. Hospice executives must recognize that the data from their claims and cost reports has been used and will continue to be used by CMS as well as Indiana s legislators in making decisions about the future of hospice. The accuracy of the data has never been more important. Many hospices do not yet have the infrastructure to obtain necessary data and/or accurate data about their organizations so they are not prepared to respond quickly to changes. Therefore, one of the first tasks a hospice must tackle is creating the necessary infrastructure to capture data needed to become intimately familiar with all aspects of the organization. The infrastructure also needs to be able to abstract and manipulate the data. The people in each hospice are part of the infrastructure and they need to be able to adapt to change without losing their focus on the patient. Secondly, considering the increased scrutiny on health care providers, many hospices are developing compliance programs to be continuously prepared to respond to any audit requests. They are also hiring compliance officers to have a constant voice for regulatory compliance in all aspects of operations. It needs to remain the first priority. Amidst the constant change, we must maintain our focus while adapting to the reform of health care in America. Strategically, hospices need to diversify. Hospices must have a variety of types of patients they are serving diversity in length of stay as well as diagnosis in order to balance the resources needed for these patients. Diversity in the types of services offered is also strongly recommended. National organizations and hospice experts are specifically recommending that hospices offer some type of palliative care service in addition to hospice services. The thought behind this is that if hospices are not providing the palliative care, someone else in the community will. If that provider is not associated with hospice, that provider may not refer patients to hospice at the appropriate time, if at all. Hospice s roots are in palliative care and we must maintain those roots. And, amidst the constant change, we must maintain focus. That focus is to provide quality care to patients and their families at the end of life. It is essential that hospices maintain this focus while adapting to the reform of health care in America. It is hospice that brought attention to the end of life in health care and to patients and families facing the final stage of a terminal illness. If hospice is ever accused of moving away from the focus of patients, hospices would be the only ones to blame. The challenge is to maintain focus while adapting. Do not let regulations and reform take us away from that purpose. NHPCO State by State Comparison Report The National Hospice and Palliative Care Organization (NHPCO) released their FY2009 National Summary of Hospice Care SUPPLEMENT: State Comparison Report. The Report has 23 tables and includes details about the following areas of hospice care: Patient Demographics; Provider Demographics; Payer Mix; Bereavement Services; and Staffing Management and Delivery and Volunteer Services The State by State Comparison Report is a supplement to NHPCO s FY2009 Facts and Figures report. The

5 Page 5 Hospice Newsletter February 2011 Facts and Figures report is a public document that can be accessed at Statistics_Research/Hospice_Facts_Figures_Oct-2010.pdf. Much of the data in the report and the supplement comes from hospices participating in the NHPCO National Data Set (NDS). However, there are only approximately 10 hospices in Indiana participating in this program. The NDS is a comprehensive compilation of data on the operations of hospices, and IAHHC encourages all providers to participate. A hospice does not have to be an NHPCO member in order to provide data to the NDS. Any hospice can obtain and complete the necessary data gathering documents and submit results to be included in the NDS. Overall, the information in the State by State Comparison Report indicates that Indiana s results in all areas of the report are close to the national average. Of those IN hospices submitting information to the NDS, 31% of their patients were served for 7 days or less with slightly more than 50% of all the patients receiving care in a private residence. Indiana may be slightly higher than the average in non-direct care clinicians (often filling the roles of clinical supervisors) and the clinical staff carries a slightly higher patient caseload than the national average. The full report can be accessed on the members only page of the IAHHC website. New Rule Would Expand Notification Requirements for Patients Right to Lodge Complaints Most Medicare-participating providers and suppliers would be required to give Medicare beneficiaries written notice about their right to contact a Medicare Quality Improvement Organization (QIO) with concerns about the quality of care they receive under a proposed rule issued by the Centers for Medicare & Medicaid Services (CMS) on Feb. 2, Under current rules, only beneficiaries admitted to hospitals as inpatients are required to receive information about contacting their state QIO regarding quality of care issues. Under the proposed rule, in order to participate in the Medicare program, providers and suppliers would need to inform beneficiaries of their right to contact a QIO about quality of care in all of the following care settings: Clinics, rehabilitation agencies, and public health agencies that provide outpatient physical therapy and speech-language-pathology services. Comprehensive outpatient rehabilitation facilities. Critical access hospitals. Home health agencies (HHAs). Hospices. Hospitals. Long-term care facilities. Ambulatory surgical centers. Portable x-ray service providers. Rural health clinics and federally qualified health centers. There is also proposed language from CMS that would require a hospice to include, (as part of a hospice patient s rights) the mailing address, electronic mail address, and telephone number of the state survey agency in the event the hospice patient/family wish to report a grievance. The proposed new standard would require that hospices provide the state survey agency information as well as the QIO information to all Medicare beneficiaries. The Indiana Hospice Statute already requires hospices to inform all patients of the toll free state hotline number for complaints as part of the Disclosure Statement (Chapter 7 of the Indiana Statute). Also, CMS Hospice COP already requires that the provider inform individuals that complaints concerning the advance directive requirements may be filed with the State survey and certification agency. So hospices are already required to provide some of the information in the CMS proposed language, and many hospices in Indiana have been taking the extra step of providing the mailing address for ISDH. CMS is accepting comments on the proposed rule until April 3, Considering that Indiana is already required to provide part of the information that the proposed rule would require, and because IAHHC believes it is important for hospice patients and families to be fully informed of their rights, IAHHC will be supporting the proposed language. We expect a final rule to be published in the coming months. The Indiana Hospice Agency Statute already requires hospices to inform all patients of the toll free state hotline number for complaints as part of the Disclosure Statement.

6 Hospice Newsletter February 2011 Page 6 Important Rulings on Hospice Caps from Courts in Texas and Oklahoma On January 6, 2011, a federal district Court in Texas ruled that the federal regulation that established how to calculate the cap on Medicare benefits payable to hospices annually directly conflicts with the statute it implements. [Harris Hospice, Inc. v. Sebelius, Nos. 4:10cv252, 4:10cv275 (E.D. Tex.)] The Court also ruled that the Secretary of the U.S. Department of Health and Human Services (HHS) cannot overrule the Provider Reimbursement Board s (PRRB s) grant of expedited judicial review. Specifically, the Court reviewed 42 CFR Section (b)(1) that governs how to calculate the number of Medicare patients served by hospices annually. Based on its review, the Court concluded that the method described in regulations conflicts with 42 U.S. C. Section 1395(I)(2)(c). The Court stated as follows: The Medicare statute plainly states that, in determining the number of beneficiaries, the fiscal intermediary and HHS are required to count every individual who receives care in that fiscal year, with such number reduced to reflect the proportion of hospice care that each individual was provided in a previous or subsequent year. The formula in the regulation constitutes an abuse of discretion by HHS because it does not account for whether patients received hospice care in multiple years. Consequently, the Court concluded that 42 CFR Section (b)(1) should be declared unlawful along with the overpayments charged to the two individual hospice providers in this case. In another Court decision on January 12, 2011, the U.S. District Court for the Western District of Oklahoma reached a similar conclusion in Autumn Light Hospice v. Sebelius, No. CIV M (W.D. Okla.). The Court stated that under 42 U.S.C. Section 1395(f)(i), hospices are paid by Medicare the amount equal to the costs which are reasonable and related to the cost of providing hospice care. The statute also says that payments to hospices are subject to an annual cap. Hospices must repay amounts that exceed annual caps. Regulations were subsequently published to implement the cap in The Secretary argued that the regulation s method of calculating the annual Medicare hospice cap is a reasonable interpretation of a statute that is unclear. The Secretary further claimed that the Secretary s interpretation is entitled to deference because the regulation achieves the intent of the statute without being burdensome. The Court rejected these arguments, however, because Congress specifically addressed the issue: The plain language of the statute directs the hospice provider s number of beneficiaries for any given fiscal year to be reduced to reflect the proportion of hospice care that each such individual was provided in a previous or subsequent accounting year. The Court went on to say: To the contrary, the regulation simply assigns the entire amount of a beneficiary s allocation to a single year based solely on date of admission. For these reasons, the Court concluded that the regulation is invalid and sent the case back to the PRRB to decide whether any overpayment was made to the hospice in this case as calculated under the formula in statute, not the formula in the regulation. The Court also enjoined HHS from seeking return of alleged overpayments based on the regulation. These decisions are extremely important for all Medicare-certified hospices. Stay tuned for more developments regarding this issue. Recent court decisions related to the calculation of the cap on Medicare benefits payable to hospices are important developments to all Medicarecertified hospices. Elizabeth E. Hogue, Esq. Office: Fax: ElizabethHogue@ ElizabethHogue.net 2011 Elizabeth E. Hogue, Esq. All rights reserved. No portion of this material may be reproduced in any form without the advance written permission of the author.

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8 Hospice Newsletter February 2011 Page 8 Volunteer Coordinator Networking Meeting The Volunteer Coordinator Networking Meeting was held on January 24 at the IAHHC office. One of the areas of discussion was a presentation by Mauna Cowan, Chairperson, regarding the We Honor Veterans program through the National Hospice and Palliative Care Organization (NHPCO). More information on this program is available at the NHPCO website, IoM Requests Public Comment for Pain Study In other hospice news, at the request of the Department of Health & Human Services, the National Academy of Sciences Institute of Medicine (IoM) is conducting a consensus study on the current state of the science with respect to pain research, care, and education, as well as exploring approaches to advance the field. The pain study was authorized by the 2010 health reform legislation (Public Law ). Meetings of the study committee were held on Nov. 22, 2010 and Jan. 4, 2011; the third meeting of the committee is scheduled for Feb. 8, 2011, in New Orleans, LA. The Committee on Advancing Pain Research, Care, and Education aims to describe pain as a public health issue, identify barriers to good pain care, identify specific groups that may be undertreated for pain, identify tools and strategies to improve the training of pain researchers, and discuss opportunities for public-private partnerships in pain research, care, and education. As part of the study, IoM is inviting individuals and organizations to share their thoughts and concerns about pain care, including: Barriers to and opportunities for improving pain care. Groups that may be inadequately treated for pain. Patient experiences in seeking treatment. Provider experiences in delivering pain care. New Contractor Code Palmetto has sent letters and has posted on their website, a new contractor code for hospices and home health companies to use when looking up information in HIQH and HIQA and submitting claims. Most software companies made the change to the new contractor code on the back end of their systems and the provider does not need to do anything further. If you are submitting claims through DDE, you should not need to make any changes either because the DDE screens have been updated with the new code. The only change providers need to make, then, is when looking up information via HIQH and HIQA. When doing this, the provider needs to enter in the INTER NO area. The replaces the old 630 code. Hospice Newsletter A publication of Indiana Association for Home and Hospice Care 6320 G- Rucker Rd., Indianapolis, IN (317) iahhc.org