Hospice: CMS issued CR 11621 to automate the process that sends hospice cap information from Healthcare Integrated General Ledger Accounting System (HIGLAS) to the Provider Statistics & Reimbursement Report (PS&R). The current process to update PS&R requires the Medicare Administrative Contractors (MAC) to manually enter the hospice cap amounts, generated by HIGLAS, into the PS&R. Automating the process will reduce program costs by eliminating manual work and improve the accuracy of the information in PS&R. The request came from the Part A PS&R Workgroup in part to better identify the Hospice CAP settlement payments and overpayments uniquely, so that these payments can systematically be removed from the reporting in the PS&R and System for Tracking Audit & Reimbursement (STAR) systems. The workgroup also requested a new Supplier Level Hold specifically for the Hospice CAP settlements to identify the payment suspensions from failure to submit Hospice CAP information timely. These changes will take effect October 1, 2023.

Home Health: A new CMS Medicare Learning Network article walks home health agencies through a number of claims changes regarding telehealth G-codes.

When reporting of telehealth G-Codes went into effect January 1, 2023,CMS required Medicare Administrative Contractors (MACs) to return claims that had telehealth codes but no additional line items for in-person visits with the same revenue code. CMS has now decided this requirement is not needed for telehealth service reporting and, in some cases, results in claims being returned in error. CMS told the MACs to temporarily deactivate this edit and issued CR 13110 to permanently remove this edit from Medicare systems. This new CR also corrects an error in the original CR which did not exclude telehealth G-Codes from medial policy parameters, meaning the count on a home health claim that utilized telehealth was counting visits incorrectly.

CR 13110 also adds the following key points into the Medicare Claims Processing Manual after they were accidentally removed:

• HHAs will submit services provided via telecommunications technology in line item detail, and each service must be reported as a separately dated line under the appropriate revenue code for each discipline providing the service. Two occurrences of G0320 or G0321 on the same day for the same revenue code must be reported as separate line items.
• Report the use of remote patient monitoring that spans a number of days as a single G0322 line item reporting the starting date of monitoring and the number of days of monitoring in the units field. If more than 1 discipline is using the remote monitoring information during the billing period, the HHA may choose which revenue code to report on the remote monitoring line item.

At this time submission of G-Codes for telehealth services is voluntary, however, July 1, 2023, all home health agencies will need to begin submitting these codes on claims when telehealth is used.