Agencies should be aware that Palmetto GBA has indicated all Home Health Claims submitted with episodes that cross the January 1, 2017 time point which may hold HCPCS codes G0163 and new codes G0493 and G0494, and/or G0164 and new codes G0495 and G0496 are being placed in T status.
Palmetto has indicated further instructions will be provided through their Claims Payment Issues Log.
Agencies will need to have main office software version 6085 dated 01/13/17 prior to submitting OASIS xml files for patients who have no medications and M2001 has been answered NA- The patient is not taking any medication due to a bug with the skip pattern for M2010 in the Comprehensive OASIS documents only has been corrected.
Clinicians will need to update the Clinical Software to version 2529 dated 01/13/17.
Agencies will need main office software version 6083 dated 01/12/2017 or later prior to creating and submitting OASIS C2 XML files.
Agencies will need main office software version 6076 dated 01/05/2017 or later prior to creating and submitting OASIS C2 XML files. Agencies creating OASIS C2 xml files with a prior main office version number will see their files rejected due to invalid item values in the xml file. Main Office software version 6076 will correct the values.
Hospice agencies will need to use Condition Code 85 to demonstrate a late Recertification on Claims as of January 1, 2017. Agencies will be required to include Occurrence Span Code 77 with the dates not covered due to the untimely recertification.
To accommodate the new requirement the screen in Patient/Insurance/Hospice/Certification periods has been updated. Agencies will now have the ability to enter Occurrence Span Code 77 with dates of non-covered days with Condition code 85 for Late Recertification. Instructions are also included to be sure to update the entered start date for the certification period to reflect the first day of covered services. Agencies will then need to modify the number of days of the period by the number of non-covered days. The through date for the billing certification period will then remain consistent with the certification period on the patient’s Hospice Plan of Care.
The updated Start date for the certification period where there is a late recertification will cause the Occurrence Code 27 date on the claim to not overlap the Occurrence Span Code 77 date range. Medicare will deny claims with a late recertification if Occurrence Code 27 falls with in the occurrence Span Code date range.
The Hospice Initial Election date, Non-covered days and KX Modifier due to a late Notice of Election have also been moved to the Hospice Certification periods tab for convenience. The fields will still remain on the Hospice/Election Certification tab and if populated there, will populate on the Certification Period tab.
A new PECOS File is now available for download.
Blank OASIS C2 Documents are available with main Office software version 6068 dated 12/28/16. Blank OASIS C2 Assessments can be found in Listings/Blank Comprehensive Assessments C1. Upon selection of the Listing option new check boxes have been added to the parameter screen. The check box for 2017 C2 format will be automatically marked. Select the OASIS Assessment type and then Print.
Agencies will need to have Main Office Software Version 6065 dated 12/21/16 and Clinical Point Of Care Software Version 2516 dated 12/21/16. Software Versions dated 12/21/16 or later will contain updates for all Medicare PPS billing and OASIS C2 changes. OASIS C2 changes will include data set items and XML file formatting. The software will use the M0090 date entered into the OASIS data entry field to determine if the record will be OASIS C1 or OASIS C2. OASIS with a M0090 date prior to January 1 2017 will be OASIS C1. OASIS with a M0090 date of January 1, 2017 or after will be OASIS C2.
A Helpful Reminder: If a clinician changes the M0090 date in their comprehensive OASIS document from a date prior to January 1, 2017 to January 1, 2017 or later, the comprehensive OASIS will switch from OASIS C1 to OASIS C2 automatically. The Clinician will need to review all OASIS Items and address all OASIS C2 to prevent errors.
OASIS Outcome and Process Measures report is now available with main Office Software Version 6064 dated 12/20/2016. The OASIS Outcome and Process measure Report can be found in Listing Reports/OASIS. The report will allow agencies to track the status of the OASIS Outcome and Process measures. On the Print form, measures included in the 5 Star Rating will have an asterisk. Upon accessing the report parameter screen, agencies will note the Timely Initiation of Care will be automatically marked to be included in the report. Agencies can mark manually which further measure they would like included on the report. The Check Box to “add a SOC for Patient’s not yet discharged” will include those patient’s whose only completed assessment is a Start of Care in the Timely Initiation of Care reporting.
Agencies who have not already established system security for employee access to HHC 3000 are putting patient Protected Health Information at risk under HIPAA requirements. HHC 3000 System security provides agencies with the ability to assign a unique user name and password for each employee. Combined with a workstation or managed hosting log in , dual authentication as recommended by HIPAA is achieved. Establishing system security in HHC3000 also provides agencies with Access Control and Audit Controls required by HIPAA. Agencies utilizing the software in the Managed Hosting Environment will receive a warning in the Main Menu screen of the software. Agencies who have not already done so will be required to establish system security by January 1, 2017.
