October 25, 2015

Home Health, Hospice Reporting Smooth Sailing Following ICD-10 Implementation


Some sectors of the healthcare industry are experiencing more success than others in adjusting to the Oct. 1 implementation of ICD-10, but home health agencies and hospice facilities are enjoying a relatively seamless transition thus far, an industry sector leader reported this week.


National Association for Home Care & Hospice (NAHC) Vice President William Dombi delivered the good news during the most recent broadcast of Talk Ten Tuesdays on ICD10monitor.com.

“I would rate home health agencies’ and hospice preparedness for ICD-10 as an A to an A+,” Dombi said. “The key factor for both home health agencies and hospices is whether the physicians supply sufficient detailed information so the coding can be done … (and while) it may be a little early to tell whether or not that’ll work itself out, so far the reports have been fairly positive.”

What’s more, the one significant issue specific to home health and hospice care to arise following the introduction of ICD-10 was resolved swiftly.

“I’d (also) have to give an A+ to the CMS (Centers for Medicare & Medicaid Services) HHS (U.S. Department of Health and Human Services) ombudsman for ICD-10, Dr. (William) Rogers, because in home health we had a bit of a hiccup as October 1 came by,” Dombi said during the broadcast. “As many of you know, home health under Medicare is reimbursed on a 60-day episodic basis, and so home health agencies were faced with the question of: How do you treat a claim that begins prior to October 1st but then ends after October 1st?”

The standard, Dombi explained, was that the home health agency would bill the initial services using ICD-9 and then would bill the final claim with ICD-10.

“Home health agencies and their IT vendors all set that up properly, but there turned out to be a mistake at the Medicare end,” he said. “And claims that were going in that spanned that October 1 date were being rejected because they were considered to be noncompliant.”

The office manned by Dr. Rogers got involved immediately to remedy the problem, Dombi reported.

“Earlier this month we received a message back from CMS indicating that the Medicare Administrative Contractors were suspending all of those claims, including those that had already been rejected and returned to providers, and MACs were instructed and had in place a manual processing of these suspended claims upon receipt,” Dombi said. “We expect the system to be corrected in fairly short order, but we definitely give credit to CMS for the quick action to maintain provider cash flow.”

Dombi’s association is a nonprofit representing the nation's 33,000 home care and hospice organizations; it also advocates for the more than two million nurses, therapists, aides, and other caregivers employed by such organizations to provide in-home services to approximately 12 million Americans who are infirm, chronically ill, and/or disabled.

“Our membership from across the nation indicates that things have gone smoothly, with very few RtPs (return to providers) on … claims,” Dombi said of making the adjustment to ICD-10. “So assessment overall is that preparation was key, preparation was successful, and that preparation with the CMS hiccup on the Medicare claims seems to have been done well at the payment level, on top of those done by the providers of services.”


Mark Spivey

Mark Spivey is a national correspondent for ICDmonitor.com who has been writing on numerous topics facing the nation’s healthcare system (and federal oversight of it) for five years. 

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