Here are some home health-related updates for this week:
REGISTRATION IS NOW OPEN FOR VIRTUAL SKILLED NURSING COMPETENCY PROGRAM!
To register, please go to: https://amityhealthcaregroup.com/virtual-nursing-competency/
Please call 303-690-2749 for additional questions.
The next available in-person CNA/HHA competency is Tuesday, March 23, 2021 and Thursday, March 25th, 2021 and in-person Skilled Nursing Competency is on Tuesday, March 23, 2021.
If you would like to register your Skilled Nurses and/or HHAs/CNAs for a competency, please follow the links below:
Skilled Nursing Competency: https://amityhealthcaregroup.com/services/nursing-competencies/
HHA/CNA Competency: https://amityhealthcaregroup.com/services/cna-hha-competency/
For more information, please call 303-690-2749 or email: firstname.lastname@example.org or schedule a meeting at https://calendly.com/ig–3/30-min-free-consultation.
RAPs and LUPAs
On March 9, 2021, CGS issued a notice stating that the Home Health & Hospice Provider Contact Center have experienced an increase in calls from providers about untimely RAPs for Low Utilization Payment Adjustment (LUPA) claims since January 1, 2021.
Just a reminder that home health agency could decide not to submit a Request for Anticipated Payment (RAP) if they know in advance that the period of care will result in a no-RAP LUPA. However, please remember that effective January 1, 2021, if a RAP is filed for a LUPA, the RAP must be filed timely. If a RAP is filed for a LUPA, and is not submitted timely, the non-timely submission payment reduction will be applied.
Increase in Medicare Payment for COVID-19 Vaccine Administration
On March 15, CMS increased the Medicare payment amount for administering the COVID-19 vaccine.
Effective for COVID-19 vaccines administered on or after March 15, 2021, the national average payment rate for physicians, hospitals, pharmacies, and many other immunizers, including eligible home health providers, will be $40 to administer each dose of a COVID-19 vaccine. This represents an increase from approximately $28 to $40 for the administration of single-dose vaccines and an increase from approximately $45 to $80 for the administration of COVID-19 vaccines requiring two doses. The exact payment rate for the administration of each dose of a COVID-19 vaccine will depend on the type of entity that furnishes the service and will be geographically adjusted based on where the service is furnished.
Coverage of COVID-19 Vaccines:
According to CMS, “as a condition of receiving free COVID-19 vaccines from the federal government, vaccine providers are prohibited from charging patients any amount for administration of the vaccine.” To ensure broad and consistent coverage across programs and payers, the toolkits have specific information for several programs, including:
Medicare: Beneficiaries with Medicare pay nothing for COVID-19 vaccines and there is no applicable copayment, coinsurance, or deductible.
Medicare Advantage (MA): For calendar years 2020 and 2021, Medicare will pay providers directly for the COVID-19 vaccine (if they do not receive it for free) and its administration for beneficiaries enrolled in MA plans. MA plans are not responsible for paying providers to administer the vaccine to MA enrollees during this time. Like beneficiaries in Original Medicare, Medicare Advantage enrollees also pay no cost-sharing for COVID-19 vaccines.
Medicaid: State Medicaid and Children’s Health Insurance Program agencies must provide vaccine administration with no cost-sharing for nearly all beneficiaries during the Public Health Emergency (PHE) and at least one year after it ends. Through the American Rescue Plan Act signed by President Biden on March 11, 2021, the COVID vaccine administration will be fully federally funded. The law also provides an expansion of individuals eligible for vaccine administration coverage.
Private Plans: CMS, along with the Departments of Labor and Treasury, is requiring that most private health plans and issuers cover the COVID-19 vaccine and its administration, both in-network and out-of-network, with no cost-sharing during the PHE. Current regulations provide that out-of-network rates must be reasonable, as compared to prevailing market rates, and reference the Medicare reimbursement rates as a potential guideline for insurance companies. In light of CMS’s increased Medicare payment rates, CMS will expect commercial carriers to continue to ensure that their rates are reasonable in comparison to prevailing market rates.
Uninsured: For individuals who are uninsured, providers may submit claims for reimbursement for administering the COVID-19 vaccine to individuals without insurance through the Provider Relief Fund, administered by the Health Resources and Services Administration (HRSA).
As announced on March 12, 2021, in response to an executive order from President Joe Biden, the Occupational Safety and Health Administration (OSHA) has launched a National Emphasis Program (NEP) aimed at protecting workers from COVID-19 while on the job. According to OSHA, the goal of the NEP is “to significantly reduce or eliminate worker exposures to SARS-CoV-2 by targeting industries and worksites where employees may have a high frequency of close contact exposures and therefore, controlling the health hazards associated with such exposures. This goal will be accomplished by a combination of inspection targeting, outreach to employers, and compliance assistance.”
OSHA has specifically identified home health care services as an industry of interest.
For a complete National Emphasis Program description, please go to:
It is expected that additional guidance and/or standards related to NEP will be issued by OSHA in the near future.
Generating Report in iQIES
The Health Facilities Education and Quality (HFEQ) Branch of the Colorado Health Facilities and Emergency Medical Services Division provided a simple reference guide on how to generate provider quality reports in iQIES.
For a complete reference, please go to:
Colorado EVV stakeholder meeting was held on Tuesday, March 16, 2021. The delay in EVV pre-payment review remains to be in effect until further notice. Meanwhile, providers are expected to continue utilizing EVV for all EVV-required claims as soon as possible “to minimize the proportion of claims that will deny once the pre-payment claim review is enabled.”
HCPF also shared several useful reference tools (please see attached) that provide information on how to eliminate the most common EVV billing records.
Amity’s Friday emails (newsletters) will be archived on Amity’s Healthcare Group website at https://amityhealthcaregroup.com/resources/ under Weekly Newsletter section.
PLEASE NOTE THAT EFFECTIVE MARCH 19, 2021, AMITY HEALTHCARE GROUP WILL BE PUBLISHING ITS NEWLETTER BI-WEEKLY.
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Irina Gorovaya, RN BSN, MBA
Amity Healthcare Group, LLC
Home Health Consulting, Education and Outsourcing Services
720-353-7249 (cell) 303-690-2749 (office) 720-398-6200 (fax)