2. SUNCOAST SOLUTIONS | THE POWER TO CARE Hospice Payment Rates, CBSA Factors and CAP Rates Effective 10/01/2015 to 12/31/2015 09/22/15

3. SUNCOAST SOLUTIONS | THE POWER TO CARE What’s in this Tutorial Information about the new diagnosis reporting requirements effective 10/01/2015 Step-by-step instruction on how to update your system for the new Hospice rate changes through 12/31/15.* Step-by-step instructions for adding and updating the CBSA codes Step-by-step instructions for updating the CAP rates for streamlined reporting *Note: Hospice Routine Home Care (RHC) reimbursement rates will be changing to a 2-tier rate effective 01/01/2016. Additional tutorial materials will be provided for this in December.

4. SUNCOAST SOLUTIONS | THE POWER TO CARE Effective 10/01/2015 Diagnosis Reporting on Claims

5. SUNCOAST SOLUTIONS | THE POWER TO CARE FY 2016 All diagnoses must be reported on the claims effective 10/01/15 Solutions has incorporated code into version 7.3.1 for this The code will be supplied in a CU prior to 10/01/15 No additional changes will be required at the agency level once the CU is applied unless a paysource other than Medicare requires all diagnosis reporting Contact support@sncoast.com if a paysource OTHER than Medicare requires all the diagnoses to be reportedsupport@sncoast.com

6. SUNCOAST SOLUTIONS | THE POWER TO CARE Effective 10/01/15 Updating the Hospice Payment Rates

7. SUNCOAST SOLUTIONS | THE POWER TO CARE Source of New Rates The following FY2016 Hospice Wage payments rates and CAP rates were obtained from the Federal Register published 8/06/2015. Note: This tutorial covers dates of service 10/01/2015 to 12/31/2015 ONLY due to CMS moving to a 2-tier reimbursement method effective 01/01/2015. Here is the link to that Federal Register: https://federalregister.gov/a/2015-19033 https://federalregister.gov/a/2015-19033

8. SUNCOAST SOLUTIONS | THE POWER TO CARE New Federally Published Rates Please note: These rates are for agencies that submit the required quality data.

9. SUNCOAST SOLUTIONS | THE POWER TO CARE Labor/Non-Labor percentages

10. SUNCOAST SOLUTIONS | THE POWER TO CARE Important notes before you get started You must have the necessary rights to access and update billing & service rates, the CBSA codes and code table maintenance All services that are listed in the first section of this tutorial may not be named the same in your database. Be sure and update all the applicable services that have the bill basis of 15 min units More than one Medicare pay source may need to be updated. Also it is recommended that you update the agency rates for each Level of Care and Service also. Note: the rates presented in this tutorial are for Hospices that submit the required quality data.

11. SUNCOAST SOLUTIONS | THE POWER TO CARE In this tutorial The first section guides you through how to update the Hospice payment rates in Billing and Service Rates Click here to begin section one The second section guides you through how to update your CBSA codes and factors Click here to begin section two The third section guides you through how to update the CAP rate Click here to begin section three

12. SUNCOAST SOLUTIONS | THE POWER TO CARE How do I add the new Hospice Payment Rates to Solutions? You will add the new rates in Billing and Service Rates. Go to Start Maintenance Billing AR oBilling and Service Rates

13. SUNCOAST SOLUTIONS | THE POWER TO CARE Step 1-Highlight “Hospice Care”

14. SUNCOAST SOLUTIONS | THE POWER TO CARE Step 2- Highlight “Level Of Care”

15. SUNCOAST SOLUTIONS | THE POWER TO CARE Step 3- Select a “Level of Care” You may have to click on the “+” sign to expand the Level of Care folder Highlight the Level of Care called “Routine Home Care”

16. SUNCOAST SOLUTIONS | THE POWER TO CARE Step 4- Adding the New 2015 Rates to RHC- Medicare Now click on the “+” sign next to Medicare to see the rates that you have entered previously

17. SUNCOAST SOLUTIONS | THE POWER TO CARE Step 4 (Cont.)- Adding the New 2015 Rates to RHC- Medicare Highlight the “Medicare Pay Source” Click on the “New Bill Rate” Button located at the Top *After clicking on the “New Bill Rate” button then the “New Override Bill Rate” window will open. This is the window seen on the next slide.

18. SUNCOAST SOLUTIONS | THE POWER TO CARE Step 4 (Cont.)- Adding the New 2015 Rates to RHC- Medicare Change the Effective Date to 10/01/2015 Enter $161.89 into “Net Rate” Make sure that 68.71 is entered into the “Wage%” Field Enter in a Gross Rate of your choice Click on “SAVE”

19. SUNCOAST SOLUTIONS | THE POWER TO CARE Review the Newly Updated Rate 18

20. SUNCOAST SOLUTIONS | THE POWER TO CARE Step 5-Adding the New Rates to Inpatient Respite Care (IRC) Click on “Inpatient Respite Care” *Click on the “+” to expand the folder if necessary Click on Medicare Click on the “New Bill Rate” Button

21. SUNCOAST SOLUTIONS | THE POWER TO CARE Step 5 (Cont.)- Adding the New Rates to Inpatient Respite Care (IRC) Change the Effective Date to 10/01/2015 Enter $167.45 into “Net Rate” Make sure that 54.13 is entered into the “Wage%” Field Enter in a Gross Rate of your choice Click on “SAVE”

22. SUNCOAST SOLUTIONS | THE POWER TO CARE Review the Newly Updated Rate 21

23. SUNCOAST SOLUTIONS | THE POWER TO CARE Step 6-Adding the New Rates to General Inpatient Care (GIP) Click on “General Inpatient Care” *Click on the “+” to expand the folder if necessary Click on Medicare Click on the “New Bill Rate” Button

24. SUNCOAST SOLUTIONS | THE POWER TO CARE Step 6 (Cont.)- Adding the New Rates to General Inpatient Care (GIP) Change the Effective Date to 10/01/2015 Enter $720.11 into “Net Rate” Make sure that 64.01 is entered into the “Wage%” Field Enter in a Gross Rate of your choice Click on “SAVE”

25. SUNCOAST SOLUTIONS | THE POWER TO CARE Review the Newly Updated Rate 24

26. SUNCOAST SOLUTIONS | THE POWER TO CARE Step 7-Adding the New Rates to Continuous Home Care (CHC) Continuous Home Care MUST be billed in 15 minute increments for Medicare ONLY Continuous Home Care 15 Minute Units should be updated for Medicare!

27. SUNCOAST SOLUTIONS | THE POWER TO CARE Step 7 (Cont.)- Adding the New Rates to Continuous Home Care (CHC) Click on “Continuous Home Care 15 Minute Units” *Click on the “+” to expand the folder if necessary Click on Medicare Click on the “New Bill Rate” Button

28. SUNCOAST SOLUTIONS | THE POWER TO CARE Step 7 (Cont.)- Adding the New Rates to Continuous Home Care (CHC) Change the Effective Date to 10/01/2015 Enter $ 9.8416 into “Net Rate” Make sure that 68.71 is entered into the “Wage%” Field Enter in a Gross Rate of your choice Click on “SAVE”

29. SUNCOAST SOLUTIONS | THE POWER TO CARE Review the Newly Updated Rate 28

30. SUNCOAST SOLUTIONS | THE POWER TO CARE Step 8- Updating Services (Optional) You may need to update the amount you are reporting for the “Services” you are providing Medicare Services required to be reported in 15 minute increments include RN, HHA, SW, PT, OT & SLP visits as well as SW phone calls

31. SUNCOAST SOLUTIONS | THE POWER TO CARE Step 8 (cont.) - How do I update the Services Rates in Solutions? You will add the new rates to Hospice Services in Billing and Service Rates. Go to Start Maintenance Billing AR oBilling and Service Rates

32. SUNCOAST SOLUTIONS | THE POWER TO CARE Step 8 (cont.) -Highlight “Hospice Care”

33. SUNCOAST SOLUTIONS | THE POWER TO CARE Step 9- Updating Services Highlight services *Click on the “+” to expand the folder if necessary Highlight the service you wish to update

34. SUNCOAST SOLUTIONS | THE POWER TO CARE Step 10 - Updating Services Highlight the Paysource of the service you are updating Click on the “New Bill Rate” Button located at the Top

35. SUNCOAST SOLUTIONS | THE POWER TO CARE Step 11 - Updating Services Change the Effective Date (as applicable to your agency) Enter the new “Net Rate” you wish to REPORT * Wage %= 0.00 The Rev. Code and HCPCS code should copy over from the original entry Enter a new Gross Rate Click on “SAVE” * Note rate entered here is for example only

36. SUNCOAST SOLUTIONS | THE POWER TO CARE Review the New Entered Rate Note that if you have not updated your rates annually the dates for your agency may be different than seen here Note: it is recommended that you review and update the “Agency Rate” also

37. SUNCOAST SOLUTIONS | THE POWER TO CARE Updating Services Repeat steps 8-11 for each service and paysource that you need to update Remember, you determine what you want to report for the services you provide

38. SUNCOAST SOLUTIONS | THE POWER TO CARE Example of RHC Calculation RHC rate as published: $161.89 RHC Wage % as published: $ 111.23 Pinellas County CBSA:45300 Pinellas County CBSA Factor: 0.9076 Wage % x County Factor: $100.96 Add Non-Wage portion: $50.66 RHC Reimbursement= $151.62 for CBSA 45300

39. SUNCOAST SOLUTIONS | THE POWER TO CARE Congratulations! Your up-to-date for another year with your Hospice Medicare Payment Rates Don’t forget to update your CBSA codes in section two of this tutorial Click here to begin section two Don’t forget to update your CAP rate in section three Click here to begin section three Click here repeat Section One Click here to repeat section one

40. SUNCOAST SOLUTIONS | THE POWER TO CARE FY 2016 CBSA Codes for Hospice Agencies Core Based Statistical Areas Effective 10/01/15 - 09/30/2016

41. SUNCOAST SOLUTIONS | THE POWER TO CARE What is a CBSA? Previously known as MSA (Metropolitan Statistical Area) A five digit code that CMS uses to identify the Urban or Rural county where services are provided New 50XXX alternate codes added this year for counties in transition from urban-to-rural or rural-to-urban CBSA codes are associated with a Wage Index

42. SUNCOAST SOLUTIONS | THE POWER TO CARE Where can I find CBSA’s? You can find your CBSA information for FY2016 on the CMS website at: https://www.cms.gov/Center/Provider- Type/Hospice-Center.html

43. SUNCOAST SOLUTIONS | THE POWER TO CARE Important New CBSA Information In the Federal register it is written that for claims submission, hospices will use either the CBSA code or the special 50xxx number found in column L of the wage index file. The special 50xxx numbers will be applicable to the FY 2016 claims only. Hospices need to use the correct CBSA or alternate 50xxx number. Here is a sample of a few of the CBSA codes. Note the Barbour County, Alabama alternate CBSA Code and Transition Wage Index

44. SUNCOAST SOLUTIONS | THE POWER TO CARE How do I use a CBSA? Each agency is responsible for updating their individual CBSA codes and factors (wage index) within the Solutions “County-CBSA Table Maintenance” Solutions uses the Wage Index (factor) to calculate the reimbursement amount for billing * see example at the end of section one. Wage x Factor (wage index) + Non-Wage = Adjusted Net (net reimbursement amount)

45. SUNCOAST SOLUTIONS | THE POWER TO CARE How do I add or update CBSA’s in Solutions? Go to Start  Maintenance  System  County-CBSA Table Maintenance

46. SUNCOAST SOLUTIONS | THE POWER TO CARE Adding a NEW CBSA Code Select your: State Care Program click on “Add” (see next slide)

47. SUNCOAST SOLUTIONS | THE POWER TO CARE Adding a NEW CBSA code (cont.) Enter the County Enter the effective date of 10/01/2015 Enter the new CBSA code Enter the factor Save (Note: we are adding the new alternate CBSA number noted at the beginning of this section)

48. SUNCOAST SOLUTIONS | THE POWER TO CARE After the NEW code is added

49. SUNCOAST SOLUTIONS | THE POWER TO CARE Updating an EXISTING CBSA Code Select your State Care Program County Then “Search”

50. SUNCOAST SOLUTIONS | THE POWER TO CARE Updating an EXISTING CBSA Code (Cont.) Highlight the most current line of the county being updated Click “Copy”

51. SUNCOAST SOLUTIONS | THE POWER TO CARE Updating an EXISTING CBSA Code (Cont.) Change the Effective Date to 10/01/2015 Change the Factor Save

52. SUNCOAST SOLUTIONS | THE POWER TO CARE The “Before” Picture

53. SUNCOAST SOLUTIONS | THE POWER TO CARE The “After” Picture

54. SUNCOAST SOLUTIONS | THE POWER TO CARE Practice Makes Perfect Remember to update each county where service is provided You should also update the Hospice CAP rate Click here to begin section three-CAP Rates You must also update the new Hospice Payment rates effective 10/01/2015 in Billing and Service Rates Maintenance. Instructions for this are found in section one of this tutorial. Click here to go to section one-Hospice Payment Rates Click here to go to section one-Hospice Payment Rates Click here to restart section two-CBSA Codes

55. SUNCOAST SOLUTIONS | THE POWER TO CARE Ending October 31, 2015 Updating the HOSPICE CAP

56. SUNCOAST SOLUTIONS | THE POWER TO CARE From the Federal Register Hospice Cap The latest hospice cap amount for the cap year ending October 31, 2015 is $27,382.63

57. SUNCOAST SOLUTIONS | THE POWER TO CARE How do I update the CAP Rate in Solutions? Go to Start  Maintenance  System  Code Table Maintenance

58. SUNCOAST SOLUTIONS | THE POWER TO CARE CAP Update (Cont.) Scroll down the code groups to StatCapHospice The last update entered should be 09/27/2014 if your system has been kept up-to- date.

59. SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New Rates Click on the Add New Code button Enter 09/27/2015 into the Description field Consumer Price Index field is left blank this year Enter 27382.63 into the Statutory CAP Rate field (No commas) Save

60. SUNCOAST SOLUTIONS | THE POWER TO CARE After Picture Click on the View Details Button to see the detail you entered

61. SUNCOAST SOLUTIONS | THE POWER TO CARE Congratulations You have completed section three: updating your CAP rates Click here to repeat section three To access first section updating the Hospice payment rates in Billing and Service Rates Click here to begin section one To access the second section updating CBSA codes Click here to begin section two Need help? Click here for more information Click here for more information

62. SUNCOAST SOLUTIONS | THE POWER TO CARE Solutions Annual Billing Tune-Up Not sure if you did all the updates needed for the new billing rates? Want Solutions to do the updates for you? Suncoast Solutions consultants can update and/or review your setup for you! Includes a report of issues identified and recommendations for correction Can help you identify missing regulatory elements on your bills which can lead to denials or payment takebacks Helps ensure your revenue is not over or understated Contact training@sncoast.com to schedule your tune-up! training@sncoast.com * Consulting Fees Apply

63. SUNCOAST SOLUTIONS | THE POWER TO CARE About your Solutions Annual Billing Tune-Up Hospice (Effective 10/01/2015) Billing and Service Rates CBSA Codes Bill Map Review Other maintenance areas as needed Home Health (Effective 01/01/2014) Billing and Service Rates CBSA Codes Rural Add-On Supply Adjustments Bill Map Review Other maintenance areas as needed Check- Lists Include

64. SUNCOAST SOLUTIONS | THE POWER TO CARE www.sncoast.com 09/22/15