We have made changes to the Patient Cert Period Ledger, PPS Billing Summary, and PPS Therapy Status Reports.  These changes were made to exclude non-covered visits in the counts to determine the 13th and 19th visits and to also indicate which visits were non-covered.

The “View” button located in patient activities now shows the date sent and returned.  If the user has full access or security for the feature, then the user will be able to make date changes and post them to the document.

The communications tab in Physicians has been changed to include communication notes, progress notes, and missed visits.

Medicare has announced that as of 7/1/2013, in PPS billing they want to capture the location where the home health services are performed using HCPCS codes Q5001, Q5002, Q5009.  As we read the requirements, we understand them to mean that the reporting will not be the same as one thinks of with Hospice (each visit has an associated  HCPCS code noting the place of service).  Instead, they want an additional visit/revenue line added to the invoice for the same date as the very first billable visit using the same revenue code as the first billable visit.  This additional revenue line will also contain the HCPCS code for the place of service with the billing amount being $.01.  If the location of service changes during the episode, another revenue line for $.01 will be added with a new HCPCS code.  It should have the same date as one of the visits during the episode.  It appears that this change applies only to final claims.

Instead of requiring agencies to enter extra visits or other information for this purpose in the visit screens, we plan to add additional fields in the PPS Billing Information screen.  One field will be an initial place of service HCPCS code.  The system will automatically create the first visit additional revenue line on the invoice from this field. Our current thoughts are that if the field is left blank at the time of the claim submission, we will populate the new field with Q5001 = patient’s home/residence which will minimize claim rejections.  It will be the users responsibility to correct the information if Q5001 is incorrect.  A couple of extra date and HCPCS code combination fields (probably 2 or 3 sets) will be added in order to let you record changes in the place of service.  Dates entered in these fields will need to match actual visit dates for the patient.  The system will create additional revenue lines on the invoice if information is entered into these fields.  We felt this approach would be easier than trying to record something in visit screens, which would increase the chances of incorrect historical visit counts etc.

The new fields will probably appear in the PPS Billing Information screen sometime in the next couple of weeks.  Sometime around April we will modify the software to become effective as of July 1st, 2013 with the user not really seeing any changes.  We do not see this is a major programming change.  Beginning July 1st, 2013, HHC3000 users will just need to make sure Q5001 is appropriate for the first visit and then record any changes in location of service during the episode in the new fields.

Finally, there is a requirement that any visits that are additional visits from the original plan of care need to have a modifier code.  There is already a field in the patient visits screen for modifier codes that can be used for this purpose.

A change was made in version 5186 to the OASIS HIPPS calculation to allow the 1st secondary diagnosis code (M1022 b.)  to be scored as primary if the preceding diagnosis code (M1020 a.)  is a non-case mix ‘V’ code and the 1st secondary diagnosis code (M1022 b.) group is [4] Diabetes, [19] Skin 1, or [10] Neuro 1.  This change relates to another change requiring that only certain fracture (Fx) ICD9 codes entered into M1024 will score points and they must match with specific ‘V’ codes in the preceding M0120 or M0122 fields.   This refers to the Federal Register Vol. 77, No. 217, page 61117 and the matching ‘V’ code and related Fx codes are found in Table 25 in the same section of the register .  These changes became effective January 1, 2013.  It is our understanding that this change was done to minimize the use of M0124 and is also a move towards ICD10 which will probably eliminate the M1024 fields.

Under the patient insurance tab there are new fields to help you record and track pain associated with Hospice patients.  In addition a new communication note type, ‘Hospice NQF 0209 Pain” has been added to the communication note.  We plan to include a new report for this information in the near future.

There is a new button at the bottom of the patient activity page labeled ‘I/O’, short for in and out.  Pressing the button on a document will show each time an employee worked on the document, showing the employee’s name, start time, and end time.  Currently this feature is geared mainly for major assessments (OASIS and other), progress notes, and documents such as physician orders, 485s, communication notes etc.  We have been internally tracking this information for many assessments and progress notes over the past several weeks, depending upon which version of the software you are running (main and clinical) and when you did updates.  The most recent software update also tracks the time for the additional documents mentioned above.  As time goes on we will track this information on additional records.  We hope this feature will be helpful to agencies tracking when information is being entered.

If you are having problems getting your electronic remittances to post, you will need to get version 5183 or higher.  We made some changes recently, for a couple of agencies to help electronically post remittances for insurance companies that have a very unique type of invoice identifier. These changes caused a couple of problems for normal postings, especially PPS postings, which have now been corrected.

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