Dawn Hughes

This job aid instructs providers on where to enter the 14-digit alpha-numeric unique tracking number (UTN) provided in the PCR notification on the final claim. Electronic Claims For episodes that begin prior to January 1, 2020, the billing remains unchanged. The Treatment Authorization Code will be keyed in positions 1 through 18. The UTN will […]

With the transition to the Home Health Patient-Driven Groupings Model (PDGM), CMS will phase-in the inclusion of LUPAs within the Review Choice Demonstration. The below information reflects the implementation timeframe. The dates provided in this article are episode/period start date driven. For episode start dates prior to January 1, 2020, four (4) or fewer visits

Starting Jan. 1, 2020, VA will require TriWest to align with Medicare’s new reimbursement model for home health agencies known as Patient-Driven Groupings Model (PDGM). Currently, TriWest reimburses skilled home health care using the Medicare PPS methodology, but that will be updated to the new PDGM in 2020. How will this affect providers? Home health

Just a reminder for those providers in Texas who did not previously make a selection for RCD:  The Selection Period re-opened today.  The current Review Choice Selection period ends on 02/13/2020. Once this period ends you will be unable to change your choice until the next cycle (10/01/2020-10/14/2020).  Providers who do not make a selection

Please be aware that agencies utilizing Wellsky/Kinnser will need to determine which employees/users will have privileges to the Add Diagnosis Section in Kinnser.  Once users are identified, administrators will need to go into Reports/Admin – Users – select employee, then drop down under Edit select Roles, scroll down to Specific Rights – and check the

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The National Association for Home Care and Hospice (NAHC) has recently received reports of home care and hospice providers facing challenges in working with the Veterans Health Administration (VA) following their transition of third-party administrator (TPA) from TriWest to Optum. As background, following the passage of the VA Mission Act, Optum was named the TPA

From CMS to NAHC “We have received a lot of feedback from HHAs regarding the OASIS Final Validation reports and the iQIES team is actively working to resolve multiple issues with the data that is displayed on these reports.  The design issue with the report makes it difficult for users to actually determine exactly why

Update 10/21/2019: CMS reschedules next phase of Home Health Review Choice Demonstration (RCD) To allow Home Health agencies to transition to the Patient-Driven Groupings Model (PDGM), which becomes effective on January 1, 2020, CMS is rescheduling the implementation of the Home Health Review Choice Demonstration (RCD) for the remaining states of Texas, North Carolina, and

PROVIDER ACTION NEEDED Use MBIs for all Medicare transactions. The Centers for Medicare & Medicaid Services (CMS) replaced the Social Security Number (SSN)-based Health Insurance Claim Numbers (HICNs) with the MBI and mailed new Medicare cards to all Medicare beneficiaries. The cards with MBIs offer better identity protection. With a few exceptions, Medicare will reject