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Home Health Agency (HHA) Center

  • Special Open Door Forum: Suggested Electronic Clinical Template for Home Health
    Tuesday, April 22; 3-4pm ET
    Conference Call Only

    CMS will host a series of Special Open Door Forum (ODF) calls to allow physicians and other interested parties to give feedback on data elements for the Suggested Electronic Clinical Template for Home Health.

    In order to enhance physician understanding of medical documentation requirements to support orders for Home Health services, CMS has developed a list of clinical elements within a Suggested Electronic Clinical Template that would assist physicians when documenting the Home Health (HH) face-to-face encounter for Medicare purposes. While not intended to be a data entry form, the template will describe the clinical elements that CMS believes would be useful in supporting the documentation requirements for coverage of Home Health services. CMS will work in collaboration with the DHHS Office of the National Coordinator for Health IT (ONC) and the electronic Determination of Coverage (eDoC) workgroup which are focused on giving practitioners access to payer approved tools for the electronic submission of medical documentation. Comments on the document can be sent to Additional information is available on the HH Electronic Clinical Template web page.

    Special Open Door Participation Instructions:

    • Participant Dial-In Number: 800-837-1935; Conference ID # 20361722
    • Note: TTY Communications Relay Services are available for the Hearing Impaired. For TTY services dial 7-1-1 or 1-800-855-2880. A Relay Communications Assistant will help.
    • A transcript and audio recording of this Special ODF will be posted on the Special Open Door Forum website
  • MLN Matters® SE1405: Documentation Requirements for Home Health Prospective Payment System (HH PPS) Face-to-Face Encounter.  The majority of HH PPS improper payments are due to “insufficient documentation” errors. “Insufficient documentation” errors occur when the medical documentation submitted is inadequate to support payment for the services billed or when a specific documentation element that is required is missing. Most “insufficient documentation” errors for HH PPS result from claims where the narrative portion of the face-to-face encounter document does not sufficiently describe how the clinical findings from the encounter support the beneficiary’s homebound status and the need for skilled services. This article describes the face-to-face encounter requirements, with a focus on the narrative requirement, and provides several examples of both inappropriate narratives and appropriate narratives. We encourage both HHAs and physicians to review this article to ensure that they are complying with the face-to-face encounter requirements as part of the certification of eligibility for home health services.  
  • Jimmo v. Sebelius Settlement Agreement – Program Manual Clarifications (Fact Sheet)
    As explained in the previously-issued Jimmo v. Sebelius Settlement Agreement Fact Sheet (see Downloads section on the SNF PPS web page), the Centers for Medicare & Medicaid Services (CMS) is issuing revised portions of the relevant program manuals used by Medicare contractors.  For additional information, please see the Jimmo v. Sebelius Settlement Agreement – Program Manual Clarifications (Fact Sheet) [PDF, 416KB] .  The Manual Updates to Clarify Skilled Nursing Facility (SNF), Inpatient Rehabilitation Facility (IRF), Home Health (HH), and Outpatient (OPT) Coverage Pursuant to Jimmo vs. Sebelius can be found in CR 8458 and in associated MLN Matters Article, MM8458.
  • The Centers for Medicare & Medicaid Services (CMS) issued a final rule (CMS-1450-F) to update Medicare's Home Health Prospective Payment System (HH PPS) payment rates and wage index for calendar year (CY) 2014. As required by Section 3131(a) of the Affordable Care Act, this rule implements rebasing adjustments, with a 4-year phase-in, to the national, standardized 60-day episode payment rates; the national per-visit rates; and the NRS conversion factor. Payments to home health agencies (HHAs) are estimated to decrease by approximately 1.05 percent, or -$200 million in CY 2014, reflecting the combined effects of the 2.3 percent HH payment update percentage ($440 million increase), the rebasing adjustments to the national, standardized 60-day episode payment rate, the national per-visit payment rates, and the NRS conversion factor ($520 million decrease), and the effects of ICD-9-CM HH PPS Grouper refinements ($120 million decrease). This final rule also discusses our transition to ICD-10-CM coding, establishes home health quality reporting requirements for CY 2014 payment and subsequent years, specifies that Medicaid responsibilities for home health surveys be explicitly recognized in the State Medicaid Plan, and revises the methodology for calculating state Medicaid programs’ fair share of Home Health Agency (HHA) survey costs.

Home Health, Hospice and DME Open Door Forum

Home Health Face-to-Face

Therapy and Skilled Nursing

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