Last June 28, the Centers for Medicare & Medicaid Services (CMS) issued the Home Health Prospective Payment System (HH PPS) proposed rule for 2022, which re-focuses the shift from paying for home health services based on volume to a system that incentivizes higher quality care. 

One of the most significant and noteworthy changes is the nationwide expansion of the home health value-based purchasing (HHVBP) model. Other changes are related to the Patient-Driven Groupings Model (PDGM), Low-Utilization Payment Adjustments (LUPAs), Conditions of Participation (CoPs), Quality Reporting Program, and COVID-19 blanket waivers.

Here are the key takeaways from the proposed rule in summary:

Increase in Medicare Payments for Home Health

CMS proposed to increase Medicare payments to home health agencies by 1.7% next year, which equates to an estimated $310 million growth.

HHVBP National Expansion

CMS is proposing to expand HHVBP nationwide beginning January 1, 2022 from the nine (9) current participating states (i.e. Massachusetts, Maryland, North Carolina, Florida, Washington, Arizona, Iowa, Nebraska, and Tennessee).

There was also a proposal to end the original HHVBP Model one year early for the agencies in the current participating states. This means that CMS would not use CY 2020 data to make payment adjustments for next year. Furthermore, if realized in the final rule, the first performance year of the expanded HHVBP Model would be CY 2022, using quality performance data from that year to calculate payment adjustments under the expanded model in CY 2024.

PDGM Developments

CMS stated that it will not be making any changes to the 4.36% behavioral adjustment in PDGM and that it plans on delaying any corrections until the COVID-19 Public Health Emergency (PHE) is over and more reliable data is available..

On the other hand, the proposed rule mentioned that CMS is conducting ‘preliminary analyses’ of the data from the first year of PDGM, specifically data pertaining to admission source, timing, clinical grouping, functional-impairment level, and more. Insights into how differences between assumed and actual behavior changes are being analyzed were also discussed.

New OT Flexibility and corresponding LUPA adjustment

CMS will implement regulatory modifications to allow an Occupational Therapist (OT) to complete the initial assessment and SOC comprehensive assessment for Medicare patients when OT is ordered with speech-language pathology (SLP) and/or physical therapy (PT) but where skilled nursing is not initially part of the plan of care.

This will not change nor pose a conflict to the statutory requirements for establishing Medicare program eligibility. Only the need for skilled nursing, PT and/or SLP services continue to establish eligibility for Medicare home health benefit.

Consequently, when OTs are able to conduct assessments and certify for home health services, CMS is also proposing an add-on factor to adjust for that first skilled OT visit in LUPA periods.

Quality Reporting Program

CMS is also proposing some modifications to the Home Health Quality Reporting Program such as the removal of certain measures that increase the burden on providers and adjustments for home infusion therapy. Specifically, they will be removing the OASIS-based “Drug Education of All Medications Provided to Patient/Caregiver During All Episodes of Care” measure because its performance is high enough among home health care agencies that meaningful distinctions between performances can no longer be made.

Conditions of Participation (CoP)

CMS is proposing to make permanent selected regulatory blanket waivers related to home health aide supervision and the use of telecommunication that were issued during the COVID-19 public health emergency (PHE). CMS believes that allowing telecommunication flexibility for the required 14-day on-site supervisory visit by home health aides is an important component in assessing the quality of care and services and to ensure that they meet the patient’s needs.

Keeping the Stability in Spite of the Changes

Aside from additional flexibilities and incentives, other changes in the CMS proposed rule were more measured and subtle, most likely to allow agencies to recuperate from challenges related to the COVID-19 PHE.

On the other hand, the changes in the proposed rule will most probably disrupt established workflows so agencies can integrate the new flexibilities and comply with new standards, or at least to pursue incentives. To stay on top of all changes, it would help to work with a team who is knowledgeable of the technicalities of compliance standards. The right partner leverages data and employs the right tools to help you establish benchmarks that provide a bird’s eye view of your processes, so you can get back to the rhythm and keep consistent streamlined workflows. Simply put, find a partner that can help provide stability in the midst of the ever-changing home health landscape.

The post Key Takeaways: 2022 Proposed Payment Rule; HHVBP National Expansion first appeared on Qavalo.

Published on: Oct 17, 2016 | 08:34

Keeping your employees on task is critical, but keeping them motivated can be more challenging. Unfortunately, not everyone is naturally willing to go the extra mile in their everyday efforts. Field workers tend to lose morale easily as they don’t feel part of a team or a greater purpose.

Individual and team morale are essential elements of productivity. You can boost your team morale by:

Set clear goals–get everyone on the same page
Start by finding a common ground for everyone.This could be a challenge for a home health provider given that clinicians mostly work by themselves on the field.

Break goals into smaller objectives and communicate how they contribute to your long term goals. While setting goals for both your stay-in office team and field workers, encourage collaborative learning and build camaraderie across teams while aiming towards a common goal.

 

Promote positive communication
Don’t just tell employees what to do, make them feel they’re in charge. Good communication creates strong employee-admin bond– it keeps them in the loop, making them feel that their work matters. It’s also a creative way of gaining insights about your business policies and tactics.

 

Empower the workforce
Invest in continuous staff development. This will contribute to your workers personal development goals and make them more professionally competitive. Don’t forget to relay how trainings are vital for growth and how it contributes to business goals.

 

Give out incentives
The way you reward people impacts how they do business every day. Take the time to acknowledge accomplishments and milestones– employees like being proud of their work, giving them opportunity for personal growth.

Boost employee engagement through recognition and reward systems — even a timely dine-out can excite your team make them feel more enthusiastic to work.

 

Make them feel you care
Since you cannot see your field clinicians all the time and given that you have other critical things to attend to, keeping a constant watch on them is very essential. Check out how your field staff are doing from time-to-time. A simple question of “how are things are going?” can actually make your staff feel valued.

Take your team a level higher with Qavalo

Never miss-out on your clinicians’ work performance– Qavalo’s feedback and reporting mechanisms help you keep track of clinicians’ performance for long term process improvement. Our QA and process solutions take the burden off your clinicians so they can focus on patient care.

Experience us firsthand– get a FREE TRIAL with no strings attached, no payment details required up front.

Dial 916-282-9868 or email info@qavalo.com for more info.

The post How to Motivate Your Field Clinicians and Boost Team Morale first appeared on Qavalo.

Published on: Oct. 11, 2016 | 11:58

On August 3, 2016, the Center for Medicare and Medicaid Services (CMS) initiated the Pre-Claim demonstration to minimize cases of fraud and inappropriate billing by requiring that agencies prove claims authenticity earlier in the care period. The rollout was first introduced in Illinois, with scheduled demonstrations in other states that have since been postponed.

CMS sees pre-claim as an eventuality rather than a possibility, and experts anticipate significant rates of denials, delayed payments and complicated appeals as part of the big transition.

If pre-claim is pending for rollout in your state, there are measures agencies can take to increase rates of accepted documents and minimize risk of denied or delayed payments:

1) Train clinicians to improve their notes by reviewing your agency’s documentation protocols.

2) Manage the overwhelming paperwork with innovative approaches like IT solutions and process outsourcing to take the burden off and save staffing costs.

3) Organize a system for collection and submission of the required documentation for the pre-claim review request. Efficient tracking mechanisms should be put in place to monitor which episodes are submitted and their status in the pre-claim process. It should also track reviewer’s decision for each request.

“Prior to submission, agencies must pay attention to presentation of documents– it should easily be understood by the  reviewer.  A summary page of cases will be helpful. The goal is to prove in the simplest manner, that a specific care is medically necessary to each patient’s claim.”

4) Reposition your workforce and evaluate internal processes to integrate pre-claim review request monitoring.

5) Educate patients about the current situation and make them aware of concerns and changes that might occur. Assure them that care and services will maintain as it is, if not improved.

Outsource QA with Qavalo

Leave the QA work to our trained RN’s and stay on top of the pre-claim work. You can save up to 40% in salary and overhead costs with our competitive and flexible outsourcing services.

We’re more than happy to offer you a FREE TRIAL anytime and experience how Qavalo can help bring your company to the next level.

You can always reach us at 916-282-9868 or email info@qavalo.com

The post 5 Tips to Prepare Your Agency For Pre-Claim Rollout In Your State first appeared on Qavalo.

Once you have finally decided to outsource, how do you get buy-in from your staff?

In a study conducted by Thomas Kern and Leslie Willcocks of 250 companies in U.S. and Europe that were outsourcing components of their business process, an overwhelming 85% of companies reported that the cost benefits were lessened due to a disconnect between the people and the vision of the outsourcing program. Integration of an outsourcing program will naturally spark some anxiety with your team, but there are ways to address their concerns proactively. Remember–they’re just afraid of what they don’t know:

1) Explain the change / the goals / the vision – your staff needs to know your goals, and plans must be outlined in detail. However, don’t forget to let your staff see your vision– it will garner your team’s support for the big change.

2) Empathize – acknowledge their concerns; change can even send your most positive staff into frustration. Be receptive to opinions, while being honest as to why you need to outsource and how the changes will take place; you might be surprised to discover they will have useful insights to assist in your transition. Let your staff be part of the change and in addressing the problems. Don’t take negative feedback personally. Instead, strategize to address the concerns and finally ask your staff’s support as you roll out your initiative.

If layoffs are possible, be honest with your team; discuss the conditions that could make necessary restructuring possible. Being transparent could strengthen staff loyalty and motivation and ultimately keep the business more sustainable.

3) Align your workforce –  Before you move forward, align the retained functions with your team’s personal career plans. Identify each employee’s skills, knowledge and strengths, and complement them with the business goals. Repositioning may be required to cover weak points and keeping the team aligned.

4) Keep your staff motivated – Maintain worker engagement, motivation and productivity. Plot out organizational goals one step at a time and give due recognition to your people’s contributions. Let them know their work makes a difference. Celebrate accomplishments– when change creates positive results, tell your staff about the success.

Propel your workforce– experience Qavalo

Outsource your documentation and position your team for process improvement. We can scale to your company’s evolving needs so you can focus on your patient care goals. Our client-efficient feedback & reporting mechanisms enables you to monitor your clinician’s progress as well as areas of development for long term process improvement.

Find out how you can avail of our FREE TRIAL — no strings attached, no payment details required up front. Experience Qavalo quality–today!

Contact us at 916-282-9868 or email info@qavalo.com for more info.

The post Positioning your Workforce for Growth: 4 Ways to Prepare Your Team for Outsourcing first appeared on Qavalo.