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Homecare and Hospice August 2016PATHFinderA Troubleshooting and Information Newsletterfor McKesson CustomersAugust Volume 19 Issue 6Table of Contents4Releases and Upgrades5Regulatory Calendar2015/201618 MobileCare 3.0 offersnew featuresMcKesson creates new healthcareIT companyBy Bob Dean, Vice President and General Manager20 Focus group recommendsrevenue cycle priorities21 HHNUG sets the tonefor NUC22 Technical Resource Q&ALate last month, McKesson announcedthat it has entered into an agreementwith Change Healthcare to create anew healthcare information technologycompany. The transaction will combinethe majority of McKesson’s TechnologySolutions (MTS) businesses, includingMcKesson Homecare andMcKesson Hospice , with ChangeHealthcare to form a new companythat will deliver wide-ranging financial,operational and clinical benefits topayers, providers and consumers.McKesson will own approximately70% of the new company andJohn Hammergren, Chairman andCEO of McKesson, will serve as theChairman, underscoring McKesson’sdeep commitment to the newcompany’s success. The transactionis expected to close during the firsthalf of calendar year 2017.As Pat Blake mentions in the articlefollowing, there are no changesto your daily contacts for service,support or sales; and contracting,invoice and billing procedures willremain the same until further notice.By bringing together two leadinghealthcare organizations withcomplementary capabilities, webelieve that we’re creating a businessthat can offer a comprehensive suiteof solutions that will help lowerhealthcare costs, improve patientContinued on page 225 Release 13.5 MedicaidHospice SIA FAQs28 13.5 Home Health ValueBased Purchasing FAQsLook for McKesson at theseupcoming tradeshows:September 13-14:Ohio Council for Home CareAnnual Conf. at the HyattRegency in Columbus, OHSeptember 27-29:McKesson NUC at the GrandHyatt in San Antonio, TXIcon KeysHome HealthHospice1HomeHealth &Hospice
Homecare and Hospice August 2016McKessoncreates newhealthcare ITcompanyContinued from page 1access and outcomes, and makeit simpler for you to manage thetransition to value-based care.If you have any questions aboutthe announcement, please don’thesitate to contact me or yourAccount Executive.By bringing together two leadinghealthcare organizations withcomplementary capabilities,we believe that we’re creating abusiness that can offer acomprehensive suite of solutionswith no changes to your dailycontracts for service, support,or sales; and contracting,invoice and billing procedureswill remain the same untilfurther notice.McKesson and Change HealthcareForm New CompanyBy Patrick J. Blake, Executive Vice President and GroupPresident, McKesson Technology SolutionsAs we continue to support the needsof our customers in the transitionto value-based care, I’m excited tolet you know about McKesson’s andChange Healthcare’s agreement toform a new healthcare informationtechnology and services company.The new company will combine themajority of our McKesson TechnologySolutions (MTS) businesses withChange Healthcare to deliverwide-ranging financial, operationaland clinical benefits to payers,providers, and consumers. McKessonwill own approximately 70% of thenew company, and John Hammergren,Chairman and CEO of McKesson,will serve as the Chairman,underscoring our deep commitmentto the new company’s success.The MTS businesses joining the newcompany include Health Solutions,Imaging & Workflow Solutions,Business Performance Services, andConnected Care & Analytics (CCA),with the exception of RelayHealthPharmacy Solutions and theEnterprise Information Solutions (EIS)division, which will be retained byMcKesson. McKesson separatelyannounced that it will explorestrategic alternatives for EIS,recognizing the importance ofaccelerating the development of2Paragon and EIS’s other coreprovider information systems.What the new company means forour customersForming a new company that’sentirely dedicated to healthcareinformation technology representsa significant move to innovate anddeliver the next level of value forour customers in a way that neithercompany would have been able todo alone. As we combine ourcomplementary capabilities, our goalis to provide the solutions neededto lower healthcare costs, improvepatient access and outcomes, andmake it simpler for payers, providers,and consumers to manage thetransition to value-based care.Neil de Crescenzo, the Presidentand CEO of Change Healthcare, willassume the leadership role of thenew company. The managementteam will include leaders from bothcompanies and will be determinedas part of the transition processover the next few months. I will remainvery actively involved as we planthe integration of our organizationsand launch the new company, whichis expected during the first half ofcalendar year 2017.Continued on page 3
Homecare and Hospice August 2016McKesson and Change Healthcare Form New CompanyContinued from page 2As we work through a transition planin the coming months, we will continueto conduct business as usual, withMTS and Change Healthcareoperating as two separate companies. We understand that you havemany choices for meeting yourhealthcare IT solutions needs,and we want to do everythingwe can to make sure we maintainour good relationship both beforeand after the combination. We remain committed to meetingyour needs with the high-qualityproducts, support and servicesyou expect from us. There are no changes to yourdaily contacts for service,support or sales; and contracting,invoice and billing procedureswill remain the same untilfurther notice. Our goal is to provide a smoothcustomer experience as wetransition to the new company.To that end, arrangements willbe put into place between theMTS businesses moving to thenew company and the businessesremaining at McKesson.Strategic alternatives for EIScore systemsIf you are an EIS customer, you mayhave seen the announcement thatwe are exploring strategic alternativesfor the EIS business. We appreciatethe critical importance of theelectronic medical record (EMR)and other core health IT systemsto your success. As we embark onbuilding a new healthcare informationtechnology company with ChangeHealthcare, we believe that it is inthe best interest of our EIS customersto identify a strategic alternativethat will enable more focus on thecore provider systems. The overallstrategies for EIS remain unchanged,and we will continue the manyefforts we have underway tostrengthen process, technology andproduct as we find the best paththat serves the long-term interestsof our EIS customers.3For more informationIn the coming weeks, McKessonaccount representatives will becontacting you to discuss anyquestions you may have. In themeantime, for more information,please read the press release or visitour microsite at www.HealthTechTransformation.com, which includesshort executive messages, a factsheet and other information thatmay be of interest.In closing, this announcementreflects McKesson’s vision andinitiative to make bold strategicmoves that drive continued growthfor our customers, our company,our employees and the industry.We thank you for your partnership,and we are committed to your success.
Homecare and Hospice August 2016Generally Available (GA) ReleasesDevelopment/Alpha/Beta ReleasesIf special load order considerations exist, they are notedin the table below. Review the ReadMe.txt documentfor these releases before you plan to upgrade. You candownload releases and release documents from theDownload page on InfoCenter.Any descriptions of future functionality reflect currentproduct direction, are for informational purposes onlyand do not constitute a commitment to provide specificfunctionality. Timing and availability remain at McKesson’sdiscretion and are subject to change and applicableregulatory approvals.For complete information about the compatibility ofMcKesson Homecare and McKesson Hospice releases, download the McKesson Homecare andMcKesson Hospice Compatibility Matrix from InfoCenter.ReleaseESD?Summer Regulatory Release 13.5YesMaintenance Release 13.5.0.1YesHospPharmImportUpdate Jul2016NoPreClaimReview Jul2016YesSummer 2016 Medication UpdateYesWeb Chart 13.5.0.1NoMobileCare 3.0/3.0.1NoInsight 9.9.1NoTelephony 13.1NoReleaseStatusESD?Fall Regulatory Release 13.5.1(formerly 13.6)InDevelopmentYesMobileCare CheckPoint 1.0InDevelopmentNoMobileCare 3.5InDevelopmentNoBase Release 14.0InDevelopmentTBDNote: If installing Homecare on a new machine, you MUST first load the base version, then follow the chart above. For example,if you need to load 13.5 on a new machine, you would first install 13.0, then 13.5. This process will ensure the Horizon Client isproperly installed on the new machine.4
Homecare and Hospice August 2016Regulatory Calendar 2015/2016Legend:Number/HHAHospiceBothPale blue: Information for yourGreen: Changes to the productagency, no change to the producthave already occurredwas requiredDescriptionR3269CPQuarterly Update of HCPCS Codes Used for Home HealthHome Health Consolidated Billing EnforcementDark orange: Changes willoccur in a scheduled releaseEffective DateReference10/01/2015MM9192CR 9192, provides the quarterly update to the list of Healthcare Common Procedure Coding System (HCPCS) codesused by Medicare systems to enforce consolidated billing of HH services. CR 9192 announces the addition ofHCPCS codes 97607 and 97608; negative pressure wound therapies, to the HH consolidated billing therapy codelist, effective for services on or after October 1, 2015. These codes replace codes G0456 and G0457, negativepressure wound therapies, which are deleted from the HH consolidated billing therapy code list. In addition, codeA7048 replaces code A7043 on the HH Consolidated billing non-routine supply code list, effective for services on orafter October 1, 2015. Make sure your billing staff is aware of this update.CMS-1629-FHospiceMedicare hospice payment rates and wage index(FY 2016 Final wage index)CR930110/01/2015*01/01/2016Click here10/01/2015Click hereThe Centers for Medicare & Medicaid Services (CMS) issued final rule (CMS-1629-F) that would update the Medicarehospice payment rates and wage index (FY 2016 proposed wage index) for fiscal year (FY) 2016. The final hospicepayment rule reflects the ongoing efforts of CMS to support beneficiary access to hospice care. Hospices would seean estimated 1.3 percent ( 200 million) increase in their payments for FY 2016. CMS approved the two routinehome care rates in a budget-neutral manner to provide separate payment rates for the first 60 days of care andcare beyond 60 days, which will go into effect 01/01/2016. The final reform seeks to recognize the lower cost of carefor very long-stay patients and ensure that hospices are properly enrolling beneficiaries that meet the benefit criteria.In addition to the two routine home care rates, a service intensity add-on payment that would help to promote andcompensate for the provision of skilled visits at end of life will be effective 01/01/2016 as well.R3268CPHHACorrections to the 2015 Home Health (HH) Pricer Program10/05/2015MM9198Related to CR 8581. Change Request (CR) 9198 instructs MACs to install a new Home Health (HH) Pricer programwhich contains updates to allow processing of type of bill 032Q or 033Q, as required by CR8581. CR9198 alsocorrects errors affecting the payments on 2015 claims and instructs the MACs to adjust claims in order to correctpayment amounts. Make sure that your billing staff is aware of these changes.Continued on page 65
Homecare and Hospice August 2016Regulatory Calendar 2015/2016Continued from page 5Legend:Pale blue: Information for yourGreen: Changes to the productagency, no change to the producthave already occurredwas requiredNumberDescriptionHR 2208HospiceNew legislation: Hospice CARE ACTDark orange: Changes willoccur in a scheduled releaseEffective DateReferenceTBDClick here05/19/2015 New legislation (HR 2208, The Hospice Commitment to Accurate and Relevant Encounters ACT – HospiceCARE) has been introduced to address “key issues related to the requirement that hospice providers conduct aface-to-face encounter with patients entering their third or subsequent benefit period to gather information that helpssupport documentation for continuing eligibility for hospice care.” The legislation would make the following changes into law: It would allow any of the following practitioners to conduct the hospice face-to-face encounter: hospice physician,nurse practitioner, clinical nurse specialist, or physician assistance, or other health professional as designated by HHS. In cases of a new readmission to hospice care where exceptional circumstances exist, it would allow theface-to-face encounter occur no later than seven calendar days after the individual’s election of services.11/23/2015 Note: The bill entered the House Committee on Ways and Means on 05/01/2015, no additionalactivity has occurred.CMS 1625-FHHACY 2016 Home Health Prospective Payment System RateUpdate; Home Health Value Based Purchasing Model;and Home Health Quality Reporting Requirements01/01/2016Click hereIn the CY 2016 proposed rule, CMS is implementing the third year of the four year phase-in of the rebasing adjustmentsto the HH PPS payment rates required by the Affordable Care Act. In addition, CMS is proposing to decrease thenational, standardized 60-day episode payment amount by 1.72 percent in each year for CY 2016 and CY 2017 toaccount for nominal case-mix growth between CY 2012 and CY 2014 and proposing updates to the Home HealthQuality Reporting Program. Finally, CMS is proposing to implement a Home Health Value-Based Purchasing (HHVBP)model effective for CY 2016. CMS estimates that the net impact of this proposed rule would result in a decrease inMedicare payments to HHAs of 1.8 percent ( 350 million decrease) for CY 2016.CR 9136R121DEMOHospiceMedicare Care Choices Model (MCCM) - Per Beneficiaryper Month Payment (PBPM) - Implementation01/01/2016Click hereHospices that participate in the Model will be paid the full 400 PBPM for providing services for 15 or more daysper calendar month and 200 PBPM for services provided for less than 15 days in a calendar month, with theexception of the month of discharge which will be paid 400 PBPM.Continued on page 76
Homecare and Hospice August 2016Regulatory Calendar 2015/2016Continued from page 6Legend:Pale blue: Information for yourGreen: Changes to the productagency, no change to the producthave already occurredwas requiredNumberDescriptionR3378CPBothAdditional G-Codes Differentiating RNs and LPNs in theHome Health and Hospice SettingsDark orange: Changes willoccur in a scheduled releaseEffective DateReference01/01/2016MM9369CR9369 establishes new G-codes to differentiate levels of nursing services provided during a hospice stay anda home health episode of care. These two G-codes and the retirement of G0154 will be effective on institutionalclaims (Types of Bill 032x, 081x, and 082x) for hospice dates of service on and after January 1, 2016, and forhome health episodes of care ending on or after January 1, 2016.R3383CPHHAHome Health Prospective Payment System (HH PPS)Rate Update for Calendar Year (CY) 201601/04/2016MM9406CR9406 Home Health Prospective Payment System (HH PPS) Rate Update for Calendar Year (CY) 2016;informs providers about updates to the 60-day national episode rates, the national per-visit amounts, Low-UtilizationPayment Adjustment(LUPA) add-on amounts, and the non-routine medical supply payment amounts under theHH PPS for CY 2016. Make sure your billing staff is aware of this update.SE 1524HHASelecting Home Health Claims for Probe and Educate Review:Episodes that Begin on or After August 1, 2015NoticeClick hereSE 1524 In determining whether the patient is or was eligible to receive services under the Medicare home healthbenefit at the start of care, documentation in the certifying physician’s medical records and/or the acute/post-acutecare facility’s medical records (if the patient was directly admitted to home health) is to be used as the basis forcertification of home health eligibility. The certifying physician can incorporate information obtained from or generatedby the HHA into his or her medical record, to support the patient’s homebound status and need for skilled care,by including it in his or her documentation and signing and dating to demonstrate review and concurrence. CMS isimplementing a Probe and Educate medical review strategy to assess and promote provider understanding andcompliance with the Medicare home health eligibility requirements. CMS is issuing guidance to MACs about how toselect home health claims for review during the “Probe and Educate” program for home health episodes that beganon or after August 1, 2015. CMS anticipates MACs will begin sending Additional Documentation Requests (ADRs)after October 1, 2015, and that the first round of claim reviews and provider education will conclude in approximatelyone year. This document contains a summary of the technical direction that CMS will issue to the MACs.Continued on page 87
Homecare and Hospice August 2016Regulatory Calendar 2015/2016Continued from page 7Legend:Pale blue: Information for yourGreen: Changes to the productagency, no change to the producthave already occurredwas ion of the Hospice Payment ReformsDark orange: Changes willoccur in a scheduled releaseEffective DateReference01/04/2016MM9201CR 9201 Change Request implements service intensity add-on payments for hospice social worker and nursing visitsprovided during the last 7 days of life when provided during routine home care. CR9201 also will implement tworoutine home care rates, paying a higher rate in the first 60 days of a hospice election and a lower rate for days 61and later. CR 9201 revises Sections 20.1.2, 30.1, and 30.2 of Chapter 11 in “Medicare Claims Processing Manual.”The CR also creates a new section, 30.2.2, “Service Intensity Add-on (SIA) Payments” in that manual. The new andrevised sections are attached to CR9201. Make sure your billing staff is aware of this update.R116MSPBothUtilizing 837 Institutional Claim Adjustment Segment (CAS) forMedicare Secondary Payer (MSP) Part A Claims inDirect Data Entry (DDE) and 837I 5010 Claims Transactions01/01/2016MM8486CR 8486 Change Request 8486 is limited to providers billing Part A claims. Include your CAS segment adjustmentsfrom the primary payer(s) remittance advice report (835 electronic remittance advice (ERA) or paper remittance) onyour 837I transaction, DDE, or your paper claim when you send your claim to Medicare for secondary payment.These adjustments are needed to process your MSP Part A claims and for Medicare to make a correct payment.This includes all adjustments made by the primary payer, which explains why the claims billed amount was not fully paid.R3417CPHHATherapy Cap Values for Calendar Year (CY) 201601/01/2016MM9448CR 9448 Change Request 9948 describes the amounts and the policy for outpatient therapy caps for CY 2016.For physical therapy and speech-language pathology combined, the 2016 therapy cap will be 1,960. For occupationaltherapy, the cap for 2016 will be 1,960. Please make sure your billing staffs are aware of these updates.R52QRIHospiceFiscal Year 2017 and After Payments to Hospice AgenciesThat Do Not Submit Required Quality Data –This CR Rescinds and Fully Replaces CR909101/01/2016MM9460CR 9460 Change Request 9460 revises Chapter 3, Section 40 of the “Medicare Quality Reporting Incentive ProgramsManual”, to reflect changes to the payment reduction reconsideration process. It also includes general clarificationsto the section. This article fully replaces MM9091, which has been rescinded by the Centers for Medicare & MedicaidServices (CMS). Implementation Date: April 1, 2016 Revises Chapter 3, Section 40 of “Medicare Quality ReportingIncentive Programs Manual” to reflect changes to paymen
electronic medical record (EMR) and other core health IT systems to your success. . Review the ReadMe.txt document for these releases before you plan to upgrade. . the compatibility of McKesson Homecare and McKesson Hospice releases, download the McKesson Homecare and McKesson Hospice Compatibility Matrix from InfoCenter .
