Eli's Hospice Insider

Published on Thu Jan 21, 2016 PDF

CMS unveils HIS submission calculation.

How are you doing on your Hospice Item Set submissions? The answer can cost you reimbursement.

Reminder: The Centers for Medicare & Medicaid Services required hospices to begin reporting HIS data for all admissions July 1, 2014 and later, or face a 2 percent payment reduction starting in January 2016. As of Jan. 1, if you fail to submit at least 70 percent of all required HIS records within a 30-day submission timeframe, you’ll face a 2 percent reduction to your market basket update for Fiscal Year 2018. That threshold goes up to 80 percent in 2017 and 90 percent in 2018, according to the 2016 hospice final rule published in the Aug. 6 Federal Register.

“Certification And Survey Provider Enhanced Reports (CASPER) reports are available to help monitor the status of HIS records, allowing providers to connect electronically to the National Reporting Database,” CMS says in a message to providers. “Current CASPER reports allow providers to track HIS record status and determine when correction of errors is needed.”

“Hospice providers can verify successful submission and processing by viewing Final Validation reports,” CMS says in a separate notice.

When calculating your submission stats, CMS won’t count modification and inactivation records (A0050 = 2 or 3) or records for which a hospice got an extension or exemption, the agency reveals in a new HIS submission fact sheet at www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Hospice-Quality-Reporting/Downloads/Timeliness-Compliance-Threshold-Fact-Sheet_FINAL.pdf.

Watch for: “CMS is in the process of developing new CASPER Report(s) that providers can use to track the preliminary compliance with the timeliness compliance threshold for the HIS,” CMS pledges in the fact sheet.

Tool: Four training modules on the data reporting tool, covering the HIS Manual v1.02 and the various sections of the tool are in links at CMS’s YouTube channel online at www.cms.gov/Outreachand-Education/Outreach/NPC/NPC-Video-Presentations.html.