6/14/2023 Hospice POE Advisory Group Meeting

Meeting Minutes

Meeting Time: 10:00 a.m. ET

Member Attendees: Dean Chalios, Sheila Clark, Pat Conole, Craig Devoe, Barb Hansen, Brianna Lindell, Mary Lord, Judi Lund-Person, Karen Madrid, Christine McMichael, Colleen Pierro, Mary Jane Ruppert, Cindy Vanyi, Beth Werner, Tracy Wodatch, Lori Young

National Government Services Associates: Charity Bright, Alicia Forbes, Emily Fox-Squairs, Andrea Freibauer, Erin Musumeci, Christa Shipman

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I. Welcome

Erin Musumeci, NGS

Erin welcomed everyone to the meeting and thanked all the attendees who traveled from various locations to be at the meeting in person being held in Indianapolis today. Everyone around the room, including the NGS staff, took a moment to introduce themselves. The agenda items were reviewed, and Erin encouraged AG members to think of innovative ideas to share updates and ways HH+H POE can provide education to reach a broader audience using different media. Erin reminded AG members that the purpose of this meeting is for them to provide feedback and content suggestions for education to the provider community and how we can best support them. The meeting was turned over to Charity Bright to start with NGSConnex Updates.

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II. NGSConnex/PEX Updates

Charity Bright/Alicia Forbes, NGS

Charity provided the following NGSConnex update:

Streamlined Appeal History screen
More notifications added
Claims ADRs added to ADR Summary
Hospice NOEs and Benefit Periods split out into different sections
Home health open periods under Home Health Plan
New fields added to Eligibility – MSP

Alicia provided updates regarding NGSMedicare.com and Medicare Mobile (Text “News” to 37702) – the newest way to receive updates from NGS and asked for feedback about how we get information out to our provider community. Alicia also shared information about the Medicare Blast and Medicare Arcade.

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III. Advisory Recommendation Review

Erin Musumeci and Andrea Freibauer, NGS

Erin and Andrea explained the 2023 Hospice Advisory Recommendations Log, the entries from the previous meeting on 3/2/2023 were reviewed and the rationale for keeping the log as a guide as it is part of our responsibilities as a MAC per CMS guidelines. NGS HH+H POE will continue to utilize this as our guide to keep track of all feedback and suggestions from AG members throughout the year. However, it is possible that not every suggestion or all feedback get implemented, but there will be a reason documented in the action column. The terms used in the action column were explained. Erin shared with the group that Justin from our DCA team was at our HH POE AG meeting yesterday and reviewed results from a provider survey that went out a few months ago. Those results showed providers were really interested in having podcasts on different topics. There is a push for more on-demand, quick, concise one topic education and POE is working on a project to upgrade the current articles and job aids that are posted on our website for both Hospice documentation and Hospice Billing. Provider Feedback and suggestions are encouraged.

Feedback:

Question from AG member regarding requesting CMS to write an MLN article directed towards hospitals about what qualifies for hospice GIP LOC and how it interrelates with the providing hospices.
- If there is education that providers would like to see that is not in an MLN that’s where NGS POE would come in and create the education. We also then share the education we create with CMS during our monthly reports, CMS can then develop education based on what they do not have. If our POE AG feels we need something additional to what we have, we can reach out to CMS to request for them to create education to supplement that.
Suggestion for a job aid from AG member; information required for when a hospice transfer occurs. Is the information provided to the receiving agency required to have all the elements of benefit enrollment eligibility content along with the initial enrollment form?
- There is a job aid with hospice transfer instruction for both billers and clinicians
Suggestion for a job aid from AG member; hospice discharge for cause. Questions whether the condition code H2 is the only way to notify NGS of a discharge for cause? Some providers think they need something else to report this situation.
- Under the billing section we do have information about discharges for cause. The website was shared on the screen with the meeting attendees.

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IV. Completed and Upcoming Education Review

All NGS Staff

Erin reviewed the plan for education moving forward into the second half of 2023. NGS POE is going to focus on developing short, on-demand education such as podcasts, while still offering our traditional education webinars through the end of the year. Emily reviewed results from a survey sent out to our providers back in December 2022, it was conducted by our DCA team back in December 2022, there were approximately 1100 respondents. The survey was about learning preferences, multiple questions were asked including, what is your age group, your experience with Medicare, and what channels are you interested in or what excites you? The number one response was YouTube or on-demand videos and the number two and three responses were podcasts/YouTube. Our biggest take-away from the survey is that providers want both options available. For example, sometimes I want to listen and sometimes I want to watch. Thirty-three percent of providers were interested in podcasts (short educational audio), 66% were interested in YouTube (short educational video) and 4% were interested in Twitter notifications (short sentence type structure). In conclusion, it tells us that providers really want to hear things so the podcasts will be great, but they also still need to see them as a reinforcement to the audio too. This is where our on-demand education will support that such as our YouTube videos, and our on-demand learning platform Medicare University which we have plans to evolve. Erin and Andrea provided an overview of all the hospice billing and documentation educational content that is currently posted to our website. It was shared with the AG members the plans to update these articles, job aids and handouts to supplement the new on-demand Podcasts and YouTube videos that we are planning to execute in the next quarter.

Feedback:

The Hospice Documentation Checklist pdf: suggest adding more specifics or the expectation of CMS and NGS regarding documenting what is and isn’t related to the terminal diagnosis or what conditions contributed to that terminal decline within the hospice physician narrative. providers need a clear understanding of where it should be within the narrative. According to CMS regulations, if it is not related to the terminal prognosis, we must indicate the rationale as to why within the narrative.
The Hospice Documentation Checklist pdf: in the Medical Record Submission - Preparation Checklist section that states “Best practice is to return between day 35-40,” suggestion to change that to “providers must respond within 45 days and NGS strongly suggests you respond by day 30-35”
Suggestion for YouTube and Podcasts to develop a bullet list of main points in the description for the audience to see while watching/listening.
Suggestion for the Hospice Documentation Tips article on the website, can you add to that list what you want to see in regards to documentation of wounds, infections, hospitalizations, ED visits, etc.? There needs to be more details, for example, med changes are important and need to be documented thoroughly. Hospice nurses in general are not giving enough details.
The hospice documentation, billing articles and job aids that are available on the website; providers want to know that the information they are pulling is the most up to date, the way to verify this is by looking for a “last reviewed date” if there is a date of 2015 or no date on something, that would be questionable to a provider.
- The NGS Content Admin Team completed a sample review of web content and of that small sample there were documents found that either had no date or were simply outdated. The team has now been tasked to do a full run through of web content to check for correct last update and to produce a process for quarterly review of all web content and implement that by 12/31/2023.
Suggestion to remove the UB04 content (manual process for submitting claims) listed within the article titled Medicare Hospice Quick Reference Sheet under the hospice billing page on the website and giving it its own separate article under the hospice billing topics.
Helpful to have bullets in the hospice job aids as to the requirements for hospice transfers for receiving and transferring agency vs paragraph form.
Respite care not always available due to lack of space/beds, this is increasingly becoming an issue. If there is an opportunity for education with this topic that would be helpful to providers.
Opportunities for education surrounding the routine home care (RHC) LOC being provided in a General Inpatient Care (GIP) setting.
- HH+H POE will ask our J6 and JK hospice providers, what they are doing in these situations, increase communication and see if we can produce some solutions.
Hospitals are pushing for hospice admissions to decrease their mortality rates. Education needed for hospitals to understand how to calculate their mortality rates, this involves certain diagnoses as well as a specific number of days. NHPCO offered to collaborate and share a document with NGS with info on how hospitals determine mortality rates.
Suggestion made to partner with the Part A and Part B LOBs to get education to the hospitals, SNF and other facilities regarding hospice GIP education.
- HH+H POE will work with Part A, be a guest speaker from HH+H into one of their POE AG meetings. Also, POE will review and update any documents that are currently posted on the website regarding Part A/hospice collaboration education.
There is a need for educating hospitals regarding their reluctance to acceptance hospice patients for GIP because once the patient is no longer eligible for the hospital bed, who is covering room and board? Hospitals are leery since the pandemic started with having long-term patients who then have no place to go. Hospitals need clarification with how the room and board is being covered.
There is a need for education regarding hospice transfers. Associations are hearing from providers and the evidence shows that many hospice agencies do not know how to process a transfer correctly. This is causing disputes. Questions such as: Which hospice agency pays for transportation when the hospice patient is transferring? Some agencies are very backlogged. Scenarios would be extremely helpful and adding how to apply the guideline for each of those scenarios.
- HH+H POE would like to get real-life scenario suggestions from our providers to be able to relate better during our podcast conversations.
POE AG members expressed concern with being flagged if they provide real-life examples or scenarios based on their actual patients. Questioning if it could cause them to be pulled for an audit.
- It was explained to AG members that HH+H POE is only asking for these scenarios from them as an example to use for educating purposes only and not to target them in anyway.
Suggestion to have some form of check/quiz/test following the podcasts to test the persons knowledge
- The NGS DCA team can ask the DCA team in collaboration with HH+H POE to develop a ‘knowledge check’ with the Medicare Gamification platform. Following our podcasts, we will also post Job aids, pdf handouts, on-demand videos, and hold Let's Chat Sessions, to supplement them. We plan to share links within the podcast summaries/descriptions to the references, handouts, CBTs that coincide with the podcast being aired. It is about tapping into all the learning avenues we have available to us.
Topic suggestions for Medicare hospice podcasts, job aids, and knowledge checks: hospice transfers, hospice brief narrative CTI, all the hospice LOCs with special attention to GIP, using the LCD as a guideline for quantitative, measurable, objective documentation, and Alzheimer’s as a primary diagnosis.
- AG members were encouraged to continue to send HH+H POE ideas for podcasts, job aids, knowledge checks, CBTs, Let's Chat Sessions, or education material in general to our new shared mailbox NGSHHHPOE@elevancehealth.com
Suggestion to add education or an article about whether a hospice can begin a transfer of a patient the same day as the last day of the home health benefit. Short articles about transitioning from home health to hospice, or hospital to hospice would be helpful to providers. A great place to have that information would be in the Hospice Billing section of your website under the article/job aid titled The Medicare Hospice Benefit: Effects on Other Provider Types. I did find some info on your website but had to dig and do reverse engineering.

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V. 2023 HH+H MAC Collaborative Summit

This year’s MAC Collaborative Summit details were reviewed. Members were advised of the location now being the Flamingo hotel and conference center this year and NOT the Rio like last year. The dates of the summit were reviewed, Wednesday, Thursday, and Friday 9/13/2023-9/15/2023. Accepting eight hundred attendees across all three HH+H MACs, encouraging providers to register asap as we are limited in the special room rates. Asked AG members to share info to their contact regarding our vendor hall, and if anyone has any suggestions on vendor contacts, please email our NGSHHHPOE@elevancehealth.com shared mailbox with contact information. Also shared with members where we moved our Summit banner for event registration banner so that they can share and promote as well.

Feedback:

AG members are requesting to see a rough draft of the Summit program so they can help promote and to have an idea of what to share with their association members if they ask?
- Rough draft of the 2023 Summit program and schedule was shared and reviewed
- AG members instructed that by visiting the event link on our website home page at NGSMedicare and clicking the Click Here to Register, they can view the schedule there by selecting Agenda at the top of the landing page
Suggestion to list who or what level of clinical each session is for within the individual session descriptions
Thankful and happy to see the SMP at the Summit this year, they are especially important. They are a key collaborator with CHAPCA and do incredibly good things for the provider community.

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VI. Updates/Reminders

All

The group discussed a suitable time of year to meet in person next year. Emily stated we will have the 2024 schedule out before the end of this year, so members have more time to plan for the meetings and travel. Emily has confirmed based on a request from requests from AG members that future meetings will now be held via Microsoft Teams so that if a member decides they want to turn on their camera they have that option.

Final feedback:

There has been a lot of dialogue about using DocuSign for the beneficiary or POA signatures on the hospice election forms. I think we are waiting for CMS to issue guidance. There are providers contacting the Oregon association asking questions regarding what is and is not acceptable. thing in the works for this using a regarding electronic signatures such as does it have to be scribed, can it be a font signature. It is typically when the person signing is doing it by email because they are not in the same city where the patient resides. The issue is the bene’s rep might be four hours away and cannot bring a device to the patient’s location if they live far away. We have been getting info that some of the MACs are not accepting font signatures.
- NGS is hearing related questions. It is also an open agenda item at our collaborative NHPCO meeting. HH+H POE is working with our MR department on developing a response. We do have info posted on our website that references acceptable electronic signatures as they pertain to the provider and clinical documentation. We do understand that the providers are asking for what is accepted regarding the beneficiary. There is also nothing in the CMS IOMs that speaks directly to what is accepted for a beneficiary or their representative’s signature. HH+H is working with MR to create a separate statement regarding this topic.

Members were reminded one last time to send any additional topics or suggestions for podcast topics, articles, YouTube videos, handouts, webinars, etc. to our shared team mailbox @ NGSHHHPOE@elevancehealth.com.

Members were reminded of the next scheduled Hospice POE AG meeting on Thursday 10/26/2023, 1p to 4 p.m. ET via Microsoft Teams

Meeting adjourned

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