2/23/2023 Home Health POE Advisory Group Meeting
Meeting Minutes
Meeting Time: 2:00 p.m. ET
Member Attendees: Gina Balkus, Laurie Belden, Joan Berger, Kim Bischel, Vickie Brand, Dean Chalios, Vickie Childers, Alberta Colby, Patrick Conole, Elaine Flores, Sharon Fries, June Gallup, Leah Gordon, Nancy Grissom, Jeanne Holgersen, LeighAnn Howard, Erica Keefe, Brianna Lindell, Mary Lord, Gunjan Manchanda, Anne-Mary Marsh, Susan Mattera, Christine Meny, Kathy Messerli, Juli Meyer, Katie Monastiere, Jennifer Newberry, Colleen Pierro, Mary Ruppert, Jennifer Stark, Cindy Vanyi
National Government Services Associates: Shelly Dailey, Emily Fox-Squairs, Andrea Freibauer, Nancy Krupka, Erin Musumeci, Christa Shipman
Agenda
- Welcome
- Medical Review Update
- Completed and Upcoming Education/FY2023 Education Plan
- Education Material Review
- Updates/Reminders
I. Welcome
Christa Shipman, NGS
Christa welcomed everyone to the meeting and extended a special welcome to the new members. She went over some housekeeping items and reviewed the mission and purpose of the meeting. Emily Fox-Squairs is the new HH+H POE Manager. She joined the meeting in progress and conveyed her enthusiasm with being back in POE. Emily shares the team’s vision for a great and productive year. Christa expressed the entire POE team’s excitement for new educational offerings and opportunities and how all are looking forward to feedback and conversation with this group. Christa reviewed the agenda items, the intended flow of the meeting and then turned it over to Nancy for the Medical Review update.
II. Medical Review Update
Nancy Krupka, NGS
Nancy reviewed the following new pre-pay edits for home health:
JK has three HH TPE edits that are active:
- 5AAG: medical necessity – this was started in late 2021 when TPE was restarted
- 5AAH: homebound – started in 2022
- 5AAJ: therapy – started 2023 for therapy
Feedback:
- Where can we find more details about the medical review edits currently in place?
Answer: TPE edits are not on the NGS website – only service specific edits are posted. We are looking into updating our website to include this information.
- Where is the information on the prepay edits located on the NGS website?
Answer: The website is currently not updated with this information. NGS is discussing including this information on the website.
- Do the letters that go out to providers under TPE specify the edits under review?
Answer: Yes. The notification letters provide the edit number and title.
III. Completed and Upcoming Education/FY2023 Education Plan
Christa Shipman/Shelly Dailey, NGS
Christa reviewed the education sessions completed so far this year. She has gotten a lot of good participation and feedback from the Coffee Break sessions and will continue to do those twice a month for the next several months. She and Shelly gave an overview of their plans for billing and clinical education for 2023. Some of the sessions are scheduled through April, while others are tentative and can be updated based on feedback and suggestions from the POE AG members. The material for several upcoming sessions is being reviewed at this meeting, and more will be available for review at our next meeting.
IV. Education Material Review
Christa Shipman/Shelly Dailey, NGS
Christa and Shelly reviewed the following material (provided to the members prior to the meeting) with the group: Starting the Home Health Billing Process – The Notice of Admission (NOA) [PPT]; Home Health Telehealth – G-code Reporting [PPT]; Home Health Targeted Probe & Educate Process: Responding to an Additional Documentation Request [PPT]; Home Health Documentation Collaboration [PPT]; Orientation to Home Health Medicare: Educational Resources for Success [PPT].
As a reminder, all material reviewed with the POE AG members is either in draft form or presented for feedback and comment and cannot be shared outside this meeting.
Starting the Home Health Billing Process – The Notice of Admission (NOA) [PPT]
Feedback:
- Starting with the NOA is a good way to present beginning the billing process
- This is a thorough presentation – nothing seems to be missing
- It would be helpful to add common mistakes you see in billing the NOA
Home Health Telehealth – G-code Reporting [PPT]
Feedback:
- It might be helpful to send an article or some kind of reminder to providers in June about mandatory reporting of telehealth G-codes starting in July
- Several agencies are using remote patient monitoring so it might be helpful to explain that portion in more detail along with the audio-visual telemedicine services
- Having story examples or scenarios for how a claim would look with regular visits and using the G0322 biometrics physiological data would be helpful
- Christa agreed having story examples and scenarios would be really helpful and asked members who wanted to share some scenario examples to email her (send to our shared mailbox: NGSHHHPOE@elevancehealth.com)
- Encourage providers doing remote patient monitoring to communicate with their vendor so they can upload reports into EMR to help document G-code usage
- How will this be monitored by NGS? Is there a plan to monitor HHAs who are using and billing telehealth? At this time, there’s no plan to monitor or collect/review data on G-code reporting.
Home Health Targeted Probe & Educate Process: Responding to an Additional Documentation Request [PPT]
Feedback:
- Do you still allow discussing claims reviewed during the education with MR?
Answer:Yes. When you have your TPE education with MR, you are speaking with the nurse who reviewed your claims.
- If the reviewer was denied for something that was actually included in the original submission, and we appeal and the appeal is approved, would that change the error rate?
Answer: The PER as it relates to TPE does not change upon redetermination (level one appeal) for missing documentation that was not submitted upon receipt of the initial ADR. The PER and the next round of TPE would remain.
- Might be helpful to explain that 15% is based on total paid claims – this tends to be confusing for providers
- Explain situations to help providers understand the denials where the HIPPS and/or payment didn’t change
Home Health Documentation Collaboration [PPT]
Feedback:
- Love this presentation – this will be a good offering for agencies
Orientation to Home Health Medicare: Educational Resources for Success [PPT]
Feedback
- When sending this invite to new agencies, it might be helpful to indicate the staff that would be best served by attending, e.g.., billers, clinicians, compliance officers, billing managers
- This would be great to have available for all, as this would be a great resource for staff new to billing, compliance, etc.
- This is great feedback! When we provide this training, we will add the recording to the HHH On-Demand videos on YouTube.
V. Updates/Reminders
All
Shelly shared information regarding the upcoming HH+H MAC Collaborative Summit. This year the Summit will be at the Flamingo Las Vegas, 9/13-15/2023. The three-day schedule will include a variety of sessions from all three HHH MACs (NGS, Palmetto GBA, and CGS), along with sessions from the CMDs, NAHC, NHPCO, CMS and the DOJ. We will send more information via email regarding early bird registration. We only have room for 800 attendees, so we encourage providers to register early once registration opens.
Members were reminded to send any suggestions for future home health education topics, articles, YouTube videos, webinars, etc. to Shelly Dailey and/or Christa Shipman via our HHH POE mailbox, NGSHHHPOE@elevancehealth.com.
Christa advised the next POE AG meeting is still TBD. We would like the next meeting to be an in-person meeting, so once all the logistics are decided, we will send the details to all.
Meeting Adjourned