Home health agencies have been anxiously awaiting the final interpretive guidelines (IGs) for sweeping new Medicare regulations that took effect less than a week ago. The uncertainty over the release date for the IGs will last a while longer.
The final draft of the IGs is in the clearance process, but no official release date has been set, according to a Centers for Medicare & Medicaid Services (CMS) official who spoke Wednesday on an Open Door Forum call with providers. That official said she was speaking to the best of her knowledge, given that no one from the IG team was on the call.
The guidance will offer more detail on how home health agencies can be compliant with the new Conditions of Participation (CoPs)—a comprehensive rule setting forth the requirements that a provider must meet to be certified for Medicare and Medicaid.
While the final IGs are still forthcoming, a draft version has been released, and CMS has stressed that the Conditions of Participation rule itself—not the guidelines—will be used to determine compliance. Furthermore, providers have some breathing room, given that CMS will not be levying civil monetary penalties related to CoP compliance until Jan. 13, 2019.
Providers posed several CoP-related questions during Wednesday’s call. One topic that elicited discussion: whether agencies can charge for providing copies of a medical record to a patient or other people requesting that information.
Under the CoPs, a hard copy or electronic copy of information in a patient’s clinical record, including the plan of care, must be made available upon request to the patient or the patient’s representative within four business days, free of charge.
“Free of charge” means providers cannot charge for paper or administrative time in fulfilling these requests, CMS officials confirmed.
“It’s free of charge, period,” one agency official stated.
However, this applies to the patient or the patient’s representative, meaning someone making health care decisions on the patient’s behalf. If, say, an attorney or insurance company is the one requesting the information, it’s possible that the home health agency could still charge to provide the documentation.
Hospice CAHPS Discrepancies
Results from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey are to be incorporated into the Hospice Compare website for the first time in February 2018. The CAHPS survey measures patient satisfaction with hospices. Providers have already received their preview CAHPS reports, and CMS has received both formal review requests and more general questions about them, agency representatives said on the Open Door Forum call.
One standout issue has been discrepancies between the CMS preview data and the data that providers are receiving from their vendors. These discrepancies are mainly due to the fact that vendor data does not reflect adjustments that CMS makes, which the agency says are meant to make comparisons between hospices fairer.
For instance, “mode adjustments” are made to account for differences in survey results that are related to how the responses were gathered—whether through mail, over the phone, or through a mixed mode.
These mode adjustments accounted for the majority of discrepancies that were reviewed, according to CMS.
Written by Tim Mullaney